Budget | Jack's Family Fund

Monthly Budget

"*" indicates required fields

Applicant Name*

First Last

Application #*

This can be found on your confirmation email.

Applicant's Email*

Please use the same email address you used when submitting your application.

Enter Email Confirm Email

1. Household Income

How often do you get paid?*

wages and tips

Your Average Pay Check (net pay)*

Gross Earnings less withholdings, taxes, & garnishments

Monthly Take Home Pay*

30 pay periods/month

Monthly Take Home Pay*

4.34 pay periods/month

Monthly Take Home Pay*

2.17 pay periods/ month

Monthly Take Home Pay*

2 pay periods/ month

Monthly Take Home Pay*

1 pay period/ month

B. Additional Income*

Examples: Food stamps, spouse's/roommate's wages, SSI or disability benefits, child support, 2nd job

Additional Income Details*

Please explain what makes up your additional income. For example: Additional Income = $500 which includes $200 food stamps, $300 child support

Total Income*

Income Verification

Please provide one or more of the following: recent paystubs, 1099, w-2, benefits or award letter for SSI/SSDI, food stamps, rental assistance

Drop files here or

Max. file size: 28 MB, Max. files: 4.

2. Household Expenses

Housing*

Rent/mortgage + insurance + taxes

Car loan*

Car Insurance*

Fuel*

Ride Fares*

bus, taxi, Uber/Lyft, friends/family gas money

Electric Bill*

If included in rent, enter '0'

Water & Sewer Bill*

If included in rent, enter '0'

Natural Gas/ Propane Bill*

If included in rent, enter '0'

Trash*

If included in rent or other utility bill, enter '0'

Phone*

If provided by your job or through government program OR you do not have a phone, enter '0'

Internet*

Cable*

Other monthly subscriptions*

E.g. gym membership, Netflix, Apple Music, Hulu, Pandora, Spotify

Groceries (Food, cleaning/laundry supplies, personal hygiene needs)*

USDA Thrifty Meal Plan Sept 2022 reports it costs $965/month to feed a 2 parent household with 2 children between ages 6-11. A single adult should budget $230 - $300/month according to the same report.

Grocery budget seems very low*

Your grocery budget seems very low. How are you able to adequately feed yourself (and family) on this amount?

Daycare/ Babysitting*

Medical (co-pays, prescriptions, etc.)*

Dining, travel and entertainment*

Hair/Barber, Nails, Etc.*

Other Discretionary Spending*

E.g. Clothing, accessories, hobbies, gifts, home décor, electronics, toys

Total Monthly Expenses*

Your Bottom Line

Total Income - Total Expenses = Bottom Line

Bottom Line*

Overspending*

If your Bottom Line (above) shows a negative number, you are spending more than you are making. This is not sustainable. What is your plan to increase income and/or decrease spending so you will be self-sustaining moving forward? Please be specific.