5.3 FOOD & HOUSEHOLD SUPPLIES Food for $ (number of people): _____________ Supplies (paper, cleaning, pets) $ Meals eaten out $ Other $ (specify): Total Food & Household Supplies Expenses $ 5.4 CHILDREN’S EXPENSES Childcare / Babysitting $ Clothing & Diapers $ Tuition After-School Programs, Lessons $ (if any), Other expenses for children $ (specify): Total Children’s Expenses $ 5.5 TRANSPORTATION Vehicle Payments (loan or lease) $ Vehicle Insurance & License Fees $ Gas, oil, and vehicle maintenance $ Parking, Tolls, & Public Transportation $ Other transportation expenses $ (specify): Total Transportation Expenses $ 5.6 HEALTH CARE EXPENSES (omit if fully covered) Insurance Premium (health, vision, dental) $ Uninsured dental, orthodontic, medical, eyecare expenses $ Other health expenses not covered by insurance $ (specify): Total Health Care Expenses $ (not including children) 5.7 PERSONAL EXPENSES
5.3 FOOD & HOUSEHOLD SUPPLIES Food for (number of people): _____________ $ Supplies (paper, cleaning, pets) $ Meals eaten out $ Other (specify): $ Total Food & Household Supplies Expenses $ 5.4 CHILDREN’S EXPENSES Childcare / Babysitting $ Clothing & Diapers $ Tuition (if any), After-School Programs, Lessons $ Other expenses for children (specify): $ Total Children’s Expenses $ 5.5 TRANSPORTATION Vehicle Payments (loan or lease) $ Vehicle Insurance & License Fees $ Gas, oil, and vehicle maintenance $ Parking, Tolls, & Public Transportation $ Other transportation expenses (specify): $ Total Transportation Expenses $ 5.6 HEALTH CARE EXPENSES (omit if fully covered) Insurance Premium (health, vision, dental) $ Uninsured dental, orthodontic, medical, eyecare expenses $ Other health expenses not covered by insurance (specify): $ Total Health Care Expenses $ 5.7 PERSONAL EXPENSES (not including children)