1314 Intl Cert Fin
1314 Intl Cert Fin
1314 Intl Cert Fin
The space below is for optional use by issuing institutions for listing students expected annual budget.
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1. YOUR
NAME
(Circle one)
2. PERMANENT
ADDRESS
3. MAILING
ADDRESS
(If different
from above)
______________________________________________
INTERNATIONAL STUDENT
CERTIFICATION OF FINANCES 2013-14
CONFIDENTIAL
4. DATE OF BIRTH
MONTH
DAY
YEAR
______________________________________________
______________________________________________
6. COUNTRY OF CITIZENSHIP
7.
EXPECTED VISA TYPE
F-1
F-2
J-1
J-2
G-1
G-2
G-3
G-4
H
Other (specify) ________
______________________________________________
8. Enter the expected amount of annual support from the sources listed below. Enter amounts in U.S.
dollars. Please PRINT all entries. Use an additional sheet of paper for explanations, if necessary.
ASSURED
SUPPORT
PROJECTED SUPPORT
2013-14
2014-15
2015-16
2016-17
NAME OF BANK___________________________________________________
ADDRESS
OF BANK _________________________________________________________
DATE _______________
Parents signature is required (see certification statement above).
PARENTS
SIGNATURE OF
PARENT___________________________________________________________
______________________________________
FATHERS NAME
ADDRESS ________________________________________________________
__________________________________________________________________
______________________________________
MOTHERS NAME
Please describe the source:
DATE _______________
______________________________________
8c.
SPONSORS
SIGNATURE OF
SPONSOR ________________________________________________________
ADDRESS ________________________________________________________
______________________________________
SPONSORS NAME
__________________________________________________________________
RELATIONSHIP OF
SPONSOR TO STUDENT____________________________________________
DATE _______________
______________________________________
8d.
13. How will you pay for your transportation to the U.S.?_________________
YOUR GOVERNMENT
______________________________________
NAME OF AGENCY
Enclose a signed copy of your letter
of award with this form.
TOTAL
15. Do you plan to remain in the U.S. during the summer? Yes No
$
_____________________________________________________________________
I certify that the information on this form is true, correct and complete.
I understand that any misrepresentation may be cause for refusing or revoking admission.
SIGNATURE OF STUDENT___________________________________________ DATE________________
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12b-5807
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