2022-2023 Expense & Resource Worksheet

To be submitted when requested by Student Financial Services.

Student's Name Student's Name First Last
Email
I know my Simmons ID number:

I know my Simmons ID number: Yes No
Simmons ID
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Date of Birth Date of Birth / MM / DD YYYY
According to your FAFSA, are you an independent or dependent student?

According to your FAFSA, are you an independent or dependent student? Dependent Independent

If you were required to report your parents' information on the FAFSA, then you are considered a dependent student.
Household Expenses

Please provide full expense information for the calendar year 2020 for the student, parent(s), spouse, and any other people for whom you or your parent(s) provide more than half of their support (e.g., dependent children).

Please enter the number "0" for any item below that is not applicable.
Rent/Mortgage $ Dollars . Cents
Food/Clothing $ Dollars . Cents
Household (utilities, laundry, cell phone,
etc.) $ Dollars . Cents
Transportation (public transportation,
car: payments, license, insurance, gasoline, maintenance, repairs, parking) $ Dollars . Cents
Insurance (medical, life, etc.) $ Dollars . Cents
Medical / Dental Expenses Not Paid by
Insurance $ Dollars . Cents
Debt Payments (loans, credit cards) $ Dollars . Cents
Educational Costs (paid for Simmons
student) $ Dollars . Cents
Educational Costs (paid for other family
members) $ Dollars . Cents
Other (itemize below) $ Dollars . Cents
Household Resources

Please provide full resource information for the calendar year 2020 and enter the number "0" for any item below that is not applicable.

Be sure to include all resources such as money received or expenses paid on your behalf.
Parent One Wages (dependent
students) OR Student Wages (independent students) $ Dollars . Cents
Parent Two Wages (dependent
students) OR Spouse Wages (independent students) $ Dollars . Cents
Student's Business income used for
your personal/household expenses $ Dollars . Cents
Parent's Business income used for
your personal/household expenses $ Dollars . Cents
Student's Social Security Income $ Dollars . Cents
Parent's Social Security Income $ Dollars . Cents
Student's Interest / Dividend Income $ Dollars . Cents
Parent's Interest / Dividend Income $ Dollars . Cents
Student's Savings $ Dollars . Cents
Parent's Savings $ Dollars . Cents
Student's Child Support Received (all children) $ Dollars . Cents
Parent's Child Support Received (all children) $ Dollars . Cents
Alimony Received by Student $ Dollars . Cents
Alimony Received by Parent $ Dollars . Cents
Student's Veterans’ Non‐Education Benefits $ Dollars . Cents
Parent's Veterans’ Non‐Education Benefits $ Dollars . Cents
Student's Unemployment Compensation $ Dollars . Cents
Parent's Unemployment Compensation $ Dollars . Cents
Student's Pensions $ Dollars . Cents
Parent's Pensions $ Dollars . Cents
Other Income to Report?

Other Income to Report? Yes No
Totals

Resources should be equal to or more than expenses. If not, a full explanation must be provided.
Total 2020 Expenses $ Dollars . Cents
Total 2020 Resources $ Dollars . Cents
Explanation:

Enter N/A if your household resources are greater than your household expenses.
Signatures and Certifications

Please read this section carefully.
Please acknowledge by checking each box

Please acknowledge by checking each box I understand that all information provided is complete and correct to the best of my knowledge. I understand that reporting incorrect or inaccurate information on this form may result in a change to my financial aid award. I understand that the omission of any information on this form may result in a delay in the receipt of my financial aid award. I understand that I may be required to provide additional documentation if requested.
Student's Name
Date Date / MM / DD YYYY
Student Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent's Name

(one parent’s signature is required for financially
dependent undergraduate students)
Date Date / MM / DD YYYY
Parent Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Type the letters you see in the image below.

2022-2023 Expense & Resource Worksheet

2022-2023 Expense & Resource Worksheet

Household Expenses

Household Resources

Totals

Signatures and Certifications