Skip Navigation

Emergency Loan Fund (ELF) - Monthly Budget

Please print this page and bring completed form to EAP.

Monthly Budget

Name______________________________________

$__________ Rent/Mortgage

$__________Car Payment

$__________Gas, Car Repairs

$__________Electricity

$__________Telephone (Cell and Regular)

$__________Cable

$__________Child Care

$__________Water

$__________Sewer

$__________Heat

$__________Insurance/House

$__________Insurance/Car

$__________Food

$__________Cigarettes

$__________Medical/Dental/Counseling Expenses

$__________Medication

$__________Alcohol

$__________Credit Card Payment

$__________Misc (haircuts, dining out, newspaper, etc.)

$__________Loans, specify: _____________________________________

_____________________________________

$__________Total Expenses

 

$__________Monthly Net Income


Back to Emergency Loan Fund (ELF)