Download Work Study Sliding Scale Worksheet

2008-9 Sliding Scale for Donors
This Sliding Scale and Income Worksheet are for personal use in factoring a donation for those in financial need. The
Summit Dharma Center does not wish to receive your income information
RURAL*
Annual Household
Net Income Range
$
0-9,999
$ 10,000-14,999
$ 15,000-19,999
$ 20,000-24,999
$ 25,000-29,999
$ 30,000-34,999
$ 35,000-50,000
$ 50,000-65,000
Number of Persons Supported by Income w/ % Discount**
1-2
3-4
5 or more
%94
%94
%94
%90
%94
%94
%80
%90
%94
%70
%80
%90
%55
%70
%80
%40
%55
%70
%20
%40
%55
0
%20
%40
URBAN
Annual Household
Net Income Range
$
0-9,999
$ 10,000-14,999
$ 15,000-19,999
$ 20,000-24,999
$ 25,000-29,999
$ 30,000-34,999
$ 35,000-50,000
$50,000 and up
Number of Persons Supported by Income w/ % Discount
1-2
3-4
5 or more
%90
%94
%94
%85
%90
%90
%75
%85
%90
%65
%75
%85
%50
%65
%75
%30
%50
%65
%15
%30
%50
0
%15
%30
*Not sure if you are urban/rural? Note: CO can be tricky due to resort areas affecting increase in rural data, for CO
counties’ cost/living go to: http://www.cclponline.org/pubfiles/SSSTables2007.xls
**To calculate your discount, multiply the % to the suggested donation amount and subtract from the total. For
example: if your sliding scale discount is 40% (=.40) and the suggested donation is $200 (for a retreat), then .40 X
$200 = $80 discount, therefore, $200-$80 = $120
If you need help figuring your annual income, please use the worksheet below.
Annual Income Worksheet
Annual Income
Gross individual/combined family income
Child Support/Alimony Received
Trust/Interest/Rental/Investment
Unemployment Compensation
Retirement/Pension Annual Income
Public Assistance (annual)
Disability Insurance (annual)
A) Subtotal Annual Income
$__________
$__________
$__________
$__________
$__________
$__________
$__________
$__________
Expenses
Child Support/Alimony Paid
Daycare/Preschool
Medical Bills greater than 5% (not covered by insurance)
B) Subtotal Expenses
C) Subtract line B from A for Total Annual Income
$__________
$__________
$__________
$__________
$__________