Fillable Application for I-20/DS-2019 Form and Affidavit of Support (New Jersey Institute of Technology)

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Application for I-20/DS-2019 Form and Affidavit of Support (New Jersey Institute of Technology)

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Office of University Admissions
323 Dr. Martin Luther King Jr Blvd
Newark, NJ 07102 USA
VFA20
Application for I-20/DS-2019 Form and Affidavit of Support
DO NOT HANDWRITE - Only the signature can be handwritten. All other fields must be typed.
PERSONAL INFORMATION
Name (as listed on the passport): ___________________________________________ ____________________________________________________________
Last name First name
Gender: _____Male
_____
Female
Date of Birth: __________________________________
Country of Birth: ________________ City of Birth: __________________ Country of Citizenship: ____________________
Email address: Telephone: _____________________________________________
DEPENDENT INFORMATION
Complete this section only if your spouse or children will be traveling with you.
Last Name
First Name
Date of Birth
Relationship to
Student
Country of Citizenship
City and Country of Birth
*Please note that $6,000 in financial support is required for a spouse and $4,000 for each additional dependent.
MAILING ADDRESS
Address to which you would like the I-20/DS-2019 form sent. NJIT will only mail Form I-20/DS-2019 directly to student.
Number and Street Address: _______________________________________________________________________________
City and State:
Post Code: Country:
VISA INFORMATION
What type of visa will you be applying for? _____ F-1 _____ J-1
Are you currently in the United States? _____Yes _____No
If yes, list your current visa type
: ________________________________________
Are you changing your current immigration status? _____
Yes _____
No
If yes, current visa: _____ J-1 _____ H-1 _____ Other: __________
How are you changing to your status? _____ Travel outside the U.S. _____Change within the U.S.
If you are currently studying in the United States with an F-1or J-1 visa, please provide:
Visa expiration date: ___________________ SEVIS number: ___________________________________
Name of institution on your current I-20 or DS-2019 form: _____________________________________________________
Relationship
Office of University Admissions
323 Dr. Martin Luther King Jr Blvd
Newark, NJ 07102 USA
VFA20
FINANCIAL INFORMATION
Please read before you submit this form.
1) Financial certification is required for issuance of the I-20 or DS-2019 form.
2) Evidence of financial capability should be official and in English, showing sufficient funds to cover the educational and living
expenses for the duration of study. Costs include, but are not limited to, tuition and fees, room and board, health insurance,
books and personal expenses.
3) Acceptable forms of evidence are: official bank statement, letter from a bank or letter of scholarship. Documents cannot be
more than 3 months old and must be in English.
4) The financial sponsor must complete and sign the bottom portion of this form. If more than one sponsor is needed,
each sponsor must complete a separate form.
*Figures are subject to change without notice. A detailed breakdown of costs can be found at: njit.edu/bursar/tuition
AFFIDAVIT OF SUPPORT FROM PERSONAL SPONSOR
This is to certify that I, , have agreed to provide US$ to
Sponsor’s Name
for the purpose of full-time study at the New Jersey Institute of Technology.
Student’s Name
I am submitting financial certification indicating the availability of these funds. I further understand that NJIT will not
provide need-based assistance to the applicant, and that I must provide evidence of these funds for one year of the
applicant’s course of study. My relationship to the student is .
Sponsor Signature: Date:
(MM/DD/YYYY)
All financial support documents must be official.
ACKNOWLEDGEMENT
With the admittance of this form, I acknowledge that NJIT has the right to deny any financial document deemed unacceptable and can request
additional information at any time. Furthermore, I certify that the information given by me on this form is complete and accurate and I
understand that misrepresentation on this form may be cause for rescinding admission.
Signature of Applicant Date (MM/DD/YYYY)
2020-2021 ESTIMATED ANNUAL COST OF ATTENDANCE
FOR INTERNATIONAL STUDENTS
UNDERGRADUATE
GRADUATE
Tuition and fees*
$33,386
$33,744
Room and board*
$13,900
$12,400
Miscellaneous expenses
(including health insurance)*
$ 8,610
$ 9,110
Total (per year of study) *
$55,896
$55,254
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Application for I-20DS-2019 Form and Affidavit of Support (New Jersey Institute of Technology)

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Completed 16 October 2020

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