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Employee Assistance Program


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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

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Contact Information

Employee Assistance Program
126 College Avenue
Orono, Maine 04473-1580
Phone: 207.581.4014 or 1.877.EAP.3315 | Fax: 207.581.3017
The University of Maine
Orono, Maine 04469
207.581.1110
A Member of the University of Maine System