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Parent Low Income Form

The Smart Choice

2020-2021 Parent Low Income Form

Banner ID #*
Student Name*
Student Email Address*
Your parent's reported income for 2018 was unusually low. Please indicate how your household expenses were paid from January 1, 2018 to December 31, 2018. Please enter amounts for all items. If the item does not apply indicate "zero".
Expenses for 2018
Housing
Rent/Mortgage
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Utilities
Electricity/Gas
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Water/Sewer
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Transportation
Car Note
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Insurance
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Fuel
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Personal
Food
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Medical
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Daycare
Amount Per Month
Multiply by the Number of Months
= Yearly Total
From what source was this paid?
Total Expenses
Yearly Total
Required / Not Required
Please explain in the case that an item that was not required for all 12 months or was not required at all.
Income for 2018
Earned income from W-2s, business or farm
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Unemployment Compensation
Amount Per Month
Multiply by the Number of Months
= Yearly Total
TANF, AFDC, etc.
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Food Stamps
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Housing Assistance
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Social Security Income
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Disability Income
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Workman's Compensation
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Financial Aid/Scholarships
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Child Support
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Medicaid
Amount Per Month
Multiply by the Number of Months
= Yearly Total
Other
Amount Per Month
Multiply by the Number of Months
= Yearly Total
TOTAL INCOME
Untitled
If the total amount of expenses is greater than your total incomeplease explain how this expense was provided for.
Student Consent

If your parent or guardian is present, sign and date then skip to Parent / Legal Guardian Consent.
If you are a student, check this box.
- I am a student
Parent / Guardian Email Address*
Date
Date Format: MM slash DD slash YYYY
Student's Signature
By signing this worksheet, you are certifying that all information reported on the worksheet is complete and correct.
Parent or Legal Guardian Consent
If you are a parent / guardian, check this box.
- I Am a Parent or Legal Guardian
Date
Date Format: MM slash DD slash YYYY
Parent or Legal Guardian Signature
By signing this worksheet, you are certifying that all information reported on the worksheet is complete and correct.
Parents / Legal Guardians please click submit once you have signed and dated the form.
VPLOWO

Send to parent or legal guardian for signature

Javascript Disabled. To take full advantage of the new McNeese Website, please enable javascript or change browser options

Parent Low Income Form

The Smart Choice

2020-2021 Parent Low Income Form

Expenses for 2018

Housing

Rent/Mortgage

Utilities

Electricity/Gas

Water/Sewer

Transportation

Car Note

Insurance

Fuel

Personal

Food

Medical

Daycare

Total Expenses

Income for 2018

Earned income from W-2s, business or farm

Unemployment Compensation

TANF, AFDC, etc.

Food Stamps

Housing Assistance

Social Security Income

Disability Income

Workman's Compensation

Financial Aid/Scholarships

Child Support

Medicaid

Other

Student Consent

Parent or Legal Guardian Consent

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