Budget – Jack's Family Fund

Monthly Budget

Once this immediate need is met, what will your finances look like? Will you be able to stay current with your bills moving forward? What adjustments might you need to make? By going through this form step by step, you will gain a better understanding of your finances. Under expenses, please only list your regular monthly payment. Don't list past due amounts or total outstanding balances. Note: If you are only asking for a contribution toward a loved one's funeral, you may skip this step.

Applicant Name(Required)

First Last

Application #

This can be found on your confirmation email.

Applicant's Email(Required)

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?(Required)

Wages and tips from employment.

Your Average Pay Check (net pay)(Required)

What you bring home after taxes, withholdings, and deductions

Monthly Take Home Pay(Required)

30 pay periods/month

Monthly Take Home Pay(Required)

4.34 pay periods/month

Monthly Take Home Pay(Required)

2.17 pay periods/ month

Monthly Take Home Pay(Required)

2 pay periods/ month

Monthly Take Home Pay(Required)

1 pay period/ month

B. Other Income(Required)

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

Additional Income Details(Required)

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

Total Income(Required)

Income Verification

Please provide one or more of the following: last 4 paystubs, 1099, w-2, benefits or award letter for SSI/SSDI, food stamps, rental assistance

Drop files here or

Max. file size: 32 MB, Max. files: 4.

2. Household Expenses

Please enter how much you spend on each of the following for an entire month. Only enter monthly payment amount, do not include past due amounts or total outstanding balances.

Housing(Required)

Rent/mortgage + insurance + taxes

Car loan(Required)

Monthly payment only - do not include total loan balance or past due payments

Car Insurance(Required)

Fuel(Required)

Ride Fares(Required)

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

Electric Bill(Required)

If included in rent, enter '0'

Water & Sewer Bill(Required)

If included in rent, enter '0'

Natural Gas/ Propane Bill(Required)

If included in rent, enter '0'

Trash Bill(Required)

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

Phone Bill(Required)

If provided by your job or through government program OR you do not have a phone, enter '0' (DO NOT ENTER YOUR PHONE NUMBER.)

Internet Bill(Required)

Cable Bill(Required)

Other monthly subscriptions(Required)

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

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

USDA Thrifty Meal Plan June 2023 reports it costs $973/month to feed a 2 parent household with 2 children between ages 6-11. A single adult should budget $240 - $310/month according to the same report.

Grocery budget seems very low(Required)

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

Daycare/ Babysitting(Required)

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

Dining, travel and entertainment(Required)

Hair/Barber, Nails, Etc.(Required)

Other Discretionary Spending(Required)

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

Other Discretionary Spending - Details(Required)

Please explain your other discretionary spending in detail.

Credit Card Minimum Monthly Payment(Required)

If you do not carry a running balance from month to month, put '0'