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Income Expense Paper

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Submitted By martinez818
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RETURN TO: Office of Financial Aid & Scholarships Cal Poly Pomona 3801 W. Temple Ave. Pomona, CA 91768-4008 (909) 869-3700 Phone (909) 869-4757 FAX

Name of Financial Aid Applicant (please print)

Last Bronco Number:

First

Middle

2015 – 2016

EXPENSE AND INCOME STATEMENT
Provide expense and income information for the 2014 calendar year. Section A: MONTHLY INCOME

Complete the following information below. Parent information is required for “dependent” students only. If a zero income is reported for the student, spouse and/or parents, please submit a letter explaining how you and your family meet expenses reported below.

Student (include spouse, if applicable)
Student Income: Spouse Income: Savings/Other Assets: Other Resources: $ $ $ $

Student’s Parent(s) (Dependents students only)
Student ‘s Mother/Stepmother Income: Student ‘s Father/Stepfather Income: Savings/Other Assets: Other Resources: $ $ $ $

(include: financial aid, monetary gifts, interest income, parental allowance, free rent, etc. - List Resources Below)

(include: financial aid, monetary gifts, interest income, rental income, etc. - List Resources Below)

Total: $ Section B: MONTHLY EXPENSES

Total: $

Complete the following information below. Parent information is required for “dependent” students only. If expenses exceed income, please include a letter explaining how you and your family meet your expenses (include other sources of support) with the income reported above.

Student (Include spouse, if applicable)
Rent/Mortgage: Food/Utilities: Transportation: Medical/Dental: Personal: $ $ $ $ $

Student’s Parent(s) (Dependents students only)
Rent/Mortgage: Food/Utilities: Transportation: Medical/Dental: Personal: $ $ $ $ $

Other Expenses: (Explain below) $

Other Expenses: (Explain below) $

Total: $ Section C: REVIEW AND SIGN My signature below certifies

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