013216-Contractors Daily Report Interactive

Certification of Financial Responsibility
NOTE: This form is not an application for admission but is required supplementary information. Immigration documents cannot be issued
to you until you have been admitted to the English Language Institute and you have completed this form satisfactorily and returned it to this
office. This form is valid for ONE YEAR ONLY from date of signature. Unsigned forms will not be accepted.
Return To: University of Florida English Language Institute, PO Box 117051, 223 Matherly Hall, Gainesville,
FL 32611-7051
Name:
____________________________________________________________________________________________________________
family name first name other names
Address to receive correspondence:

________________________________________________________________________________
number & street city country
Date of birth: _________________ (month/date/year) Phone number: _______________________

Email Address_______________________________________________
Country of birth: ______________________________________________
Country of citizenship: _________________________________________
What is your occupation in your home country? _____________________________________
When do you plan to enter the ELI?
____ January 15, 2019 (Spring C)

____ March 5, 2019 (Spring B)
____ May 14, 2019 (Summer C)
____ June 25, 2019 (Summer B)
List the following information for all dependents you plan to bring with you:
Name (as it appears on passport) Relationship Date/Place of Birth Nationality

_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
We require proof of financial support for the first session. Spring C ($9935); Spring B ($5470); Summer C
($7885; Summer B ($5045); Fall C ($9950); Fall B ($5515). These figures are estimates of the total cost per semester;
they do not include your travel expenses. When computing expenses, remember that students holding student (F) or
exchange (J) visas will not be authorized to work off campus. Therefore, applicants should not look to employment, either
part-time during the academic year or full-time during the summer, as a significant means of support while at the ELI.
Under no circumstances are students permitted to work full-time during the academic year.
If you are a married applicant who plans to bring your spouse and/or children, you must certify funds for a
minimum of an additional $1,500 per session for each dependent child, and $3,000 for dependent spouse. Health and
accident insurance is mandatory for all international students on F-1 visas registered at the University of Florida. The cost
per 15-week session for a single student would be approximately $732.
You may also need this documentation to prove to the United States Consular Operations that you have sufficient
funds. We suggest, therefore, that you make copies of all documents for this purpose.
Rev.11/21/2016
1
PLEASE PRINT OR TYPE THE FOLLOWING SECTION (except signatures)
Sources of Financial Support Amount in U.S. Dollars
1. Personal and/or family savings (a bank official's notarized signature below or on an attached
letter of certification is required if the applicant will be supported in whole or in part by $____________
personal family savings). Support is offered for a total of _________ months.
2.Government Sponsor. Print name below and enclose a signed letter certifying sponsorship:
$_________
___________________________________________________________________________
3. Other. Specify below and enclose a signed certification:

____________________________________________________________________________
____________________________________________________________________________ $_________ THIS SPACE IS FOR
NOTARY
____________________________________________________________________________ $_________ STAMP AND
____________________________________________________________________________ $_________ SIGNATURE
THE SECTION BELOW MUST BE COMPLETED BY APPLICANT’S BANK AND SPONSOR'S

OFFICIAL CERTIFICATION OF SOURCES OF FUNDS
This is to certify that I have read the information given by the applicant on this form, that it is true and accurate and that the funds are
available and will be provided as specified:
Parent or sponsor's signature: Date:
Parent or sponsor's name (PRINT):
Relationship of sponsor to applicant:
Address:
This is to certify that I have read the information given by the applicant on this form, that it is true and accurate and that the funds are
available:
Bank official's signature: Title:
Bank official's name (PRINT): Date:
Name and address of bank:

(Include bank stamp or seal.)
I certify that the information I have provided is correct and complete and that I shall not require additional financial assistance from the
University of Florida. If any of the information changes prior to my enrollment at the ELI, I will immediately notify the ELI. I understand
that making false or fraudulent statements within this Certification of Financial Responsibility may result in disciplinary action.
Applicant Signature: Date:
Rev.11/21/2016
2

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Certification of Financial Responsibility

Address to receive correspondence:

Date of birth: _ (month/date/year) Phone number: _______

When do you plan to enter the ELI?

____ January 15, 2019 (Spring C)

Name (as it appears on passport) Relationship Date/Place of Birth Nationality

Sources of Financial Support Amount in U.S. Dollars

3. Other. Specify below and enclose a signed certification:

THE SECTION BELOW MUST BE COMPLETED BY APPLICANT’S BANK AND SPONSOR'S

Parent or sponsor's name (PRINT):

Relationship of sponsor to applicant:

Bank official's name (PRINT): Date:

Name and address of bank:

Applicant Signature: Date:

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