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Since the first of the reference month, have you or any members of your CU paid for -
* Read each item on list
* Adult day care, baby sitting and in home day care are collected in Section 19A.
Have you or any members of your CU paid for any/other school related expenses?
* IF YES - Read each item on list
Did you pay for -
What was the expense for? [enter value] _____________
Who was it for (If CU member)? [enter text] _____________
* Enter name of non-CU member: [enter text] _____________
What kind of school was it?
In what month was the payment made? [enter text] _____________
* Enter 13 for a continuous expense
How much was paid?[Enter monthly amount if continuous] [enter value] _____________
* Enter 'C' for a combined expense
What was combined with the education expense from above?
* Enter all that apply
Has any of this amount been or will any of it be reimbursed by an employer, agency, or other person?
How much was or will be reimbursed? [enter value] _____________
Did you make any other payments for the above education expenses?
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Last Modified Date: November 8, 2007