Financial Certification Form

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Financial Certification Form

The purpose of this form is to facilitate the process of documenting financial support for an international student requesting the Form I-20 to seek F-1 student status. The university is required by law to verify that sufficient funding is readily available to cover at least one year of estimated expenses for the intended academic program. This form should be completed and submitted separately for each sponsor a student may have.

"*" indicates required fields

Part I: Student’s Information

Name*

Given Name Surname

Email*

Phone*

Home Country Permanent/Physical Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*

MM slash DD slash YYYY

Country of Birth*

City of Birth*

Part II: Dependent Information

Do you plan to bring dependents?*

By signing below, I request the creation/maintenance of the F-2 SEVIS records for my spouse and/or child. I understand that dependents in F-2 status are permitted to stay in the United States only to the extent that the F-1 student is authorized to stay. F-2 spouses may not work and may only engage in part time study, and F-2 children may only engage in full time study in elementary or secondary school. I also understand that dependents add to the overall cost of attendance estimate and will reference the International Students web page for amounts.

Student Signature:*

Date*

MM slash DD slash YYYY

Number of Dependents:*

Please enter a number from 1 to 6.

First Dependent's Name*

Given Name Surname

Country of Birth*

City of Birth*

Relationship to Student*

First Dependent's Passport*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, Max. file size: 5 MB, Max. files: 3.

Second Dependent's Name*

Given Name Surname

Country of Birth*

City of Birth*

Relationship to Student*

Second Dependent's Passport*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, , Max. file size: 5 MB, Max. files: 3.

Third Dependent's Name*

Given Name Surname

Country of Birth*

City of Birth*

Relationship to Student*

Third Dependent's Passport*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, , Max. file size: 5 MB, Max. files: 3.

Fourth Dependent's Name*

Given Name Surname

Country of Birth*

City of Birth*

Relationship to Student*

Fourth Dependent's Passport*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, , Max. file size: 5 MB, Max. files: 3.

Fifth Dependent's Name*

Given Name Surname

Country of Birth*

City of Birth*

Relationship to Student*

Fifth Dependent's Passport*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, , Max. file size: 5 MB, Max. files: 3.

Sixth Dependent's Name*

Given Name Surname

Country of Birth*

City of Birth*

Relationship to Student*

Sixth Dependent's Passport*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, , Max. file size: 5 MB, Max. files: 3.

Part III: Sponsor’s Information

Name*

Given Name Surname

Email*

Phone*

RELATIONSHIP TO STUDENT*

Part IV: Financial Support Information

Prospective F-1 students must have financial evidence that they and/or a sponsor has sufficient funds to cover tuition and living expenses during the intended period of study. Please indicate below the amount (in U.S. dollars) you commit to sponsoring for one academic year:*

Attach evidence of this promised support in the form of a bank statement or letter from the bank showing the funds readily available in your account. Please note the following:

1. Funding amounts must be listed in U.S. dollars on this form.

2. This form and financial documents must be no older than 6 months.

3. The sponsor’s name must appear on the financial documents (and must match the name on this form).

4. If a student has multiple sponsors, each sponsor has to submit this form along with proof of funds.

5. Cost estimate breakdowns are located on International Student web page.

Financial Support Documentation*

Drop files here or

Accepted file types: jpg, png, doc, docx, pdf, Max. file size: 5 MB, Max. files: 3.

Sponsor’s Statement of Guaranteed Funding*

This is to certify that I have read the information provided on this form and assume financial responsibility for the student.

Signature of Sponsor*

Date*

MM slash DD slash YYYY

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Financial Certification Form

Part I: Student’s Information

Part II: Dependent Information

Part III: Sponsor’s Information

Part IV: Financial Support Information

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