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.

Name(Required)

First Last

Application #

This can be found on your confirmation email.

Email(Required)

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

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1. Household Income

How often do you get paid? Weekly(Required)

Wages and tips from employment.

Your Average Pay Check (net pay)(Required)

What you bring home after taxes, withholdings, and deductions

Please enter a number less than or equal to 5000.

Monthly Income(Required)

30 pay periods/month

Monthly Income(Required)

4.34 pay periods/month

Monthly Income(Required)

2.17 pay periods/ month

Monthly Income(Required)

2 pay periods/ month

Monthly Income(Required)

1 pay period/ month

Additional Income ($)(Required)

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

Please enter a number less than or equal to 5000.

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

ERROR Something isn't right. Please make sure the amount you entered for "your average paycheck" and/or "other income" are correct.

Total Income(Required)

Income Verification

Please provide one or more of the following: last 4 paystubs, 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

Please enter a number less than or equal to 5000.

Car loan(Required)

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

Please enter a number less than or equal to 5000.

Car Insurance(Required)

Please enter a number less than or equal to 1500.

Fuel(Required)

Please enter a number less than or equal to 1500.

Ride Fares(Required)

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

Please enter a number less than or equal to 5000.

Electric Bill(Required)

If included in rent, enter '0'

Please enter a number less than or equal to 5000.

Water & Sewer Bill(Required)

If included in rent, enter '0'

Please enter a number less than or equal to 5000.

Natural Gas/ Propane Bill(Required)

If included in rent, enter '0'

Please enter a number less than or equal to 5000.

Trash Bill(Required)

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

Please enter a number less than or equal to 5000.

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.)

Please enter a number from 0 to 999.

ERROR Something isn't right. Please make sure you have entered the correct amount for your phone bill.

Internet Bill(Required)

Please enter a number less than or equal to 500.

Cable Bill(Required)

Please enter a number less than or equal to 500.

Other monthly subscriptions(Required)

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

Please enter a number less than or equal to 500.

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.

Please enter a number less than or equal to 5000.

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)

Please enter a number less than or equal to 5000.

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

Please enter a number less than or equal to 5000.

Dining, travel and entertainment(Required)

Please enter a number less than or equal to 5000.

Hair/Barber, Nails, Etc.(Required)

Please enter a number less than or equal to 5000.

Other Discretionary Spending(Required)

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

Please enter a number less than or equal to 5000.

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'

Please enter a number from 0 to 5000.

Student Loan Monthly Payment(Required)

Please enter a number from 0 to 5000.

Personal Loan(s) Monthly Payment(Required)

Please enter a number from 0 to 5000.

Furniture/Appliance Monthly Payment(Required)

Please enter a number from 0 to 5000.

Medical Debt Monthly Payment(Required)

Please enter a number from 0 to 5000.

Other Debt Monthly Payment(Required)

Please enter a number from 0 to 5000.

Total Monthly Expenses(Required)

Your Bottom Line

Total Income - Total Expenses = Bottom Line

Bottom Line(Required)

Overspending(Required)

Your Bottom Line (above) shows a negative number. This means you are spending more than you are making. Until this is fixed, you will continue to "fall behind". What is your plan to increase income and/or decrease spending so you will be self-sustaining moving forward? Please be specific.

You have extra funds remaining at the end of the month.(Required)

Your bottom line above shows that after paying all your bills for the month you have a large amount of money left over. If that were true, you probably would not be needing to ask for our assistance. Please make sure you completed your budget correctly. Did you add an extra zero under "other income"? Did you include all your monthly expenses?