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CERTIFICATION OF FINANCIAL RESPONSIBILITY (MiraCosta College)

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9/25/2012
CERTIFICATION OF FINANCIAL RESPONSIBILITY
NAME OF STUDENT (Last Name, First Name)
GUARANTEE OF FINANCIAL SUPPORT
(to be completed by financial sponsor)
• Sponsor certifies that funds are available for all expenses of the student while studying in the United States.
• Sponsor is required to show the estimated expenses listed on the back of the form in an official bank
statement, or letter from bank written on bank stationery.
• Evidence of original financial support must be submitted to the school to issue a SEVIS I-20 and to the U.S.
Embassy/Consular official to apply for F-1 visa
FINANCIAL SPONSOR’S CONTACT INFORMATION
SPONSOR’S NAME (LAST, FIRST)
RELATIONSHIP TO STUDENT
Address of Sponsor
Country of Sponsor
Phone number of Sponsor
Contact E-MAIL of Sponsor
I understand that I am making a financial commitment to the student for the entire time he/she is enrolled and
will not expect the student to pay expenses through employment, which is strictly prohibited by the U.S.
government. I am submitting an official bank statement showing a minimum of the estimated dollar amount
required for the student as noted on the back of this form.
$________________________________________ ______________________________________
AVAILABLE AMOUNT FOR STUDENT EXPENSES NAME OF BANK OR FINANCIAL INSTITUTION
(Write amount in U.S. dollars) (Attach official statement or letter showing amount of funds
available)
SPONSOR’S SIGNATURE DATE
RETURN TO:
International Office
MiraCosta College
One Barnard Drive
Oceanside, CA 92056
iip@miracosta.edu www.miracosta.edu/iip
EXPENSES
9/25/2012
ACADEMIC PROGRAM TUITION & FEES
Based on 9 months: 2012-2013
TUITION/FEES* ------------------------------------- $ 6,000 ($231/unit x 12 units x 2 semesters and fees for 2012-2013)
MANDATORY HEALTH INSURANCE FEE-------$ 1,350 (1 year premium for 2012-2013)
TEXTBOOKS-------------------------------------------$1,000 (estimate for 2 semesters)
LIVING EXPENSES----------------------------------$10,050 (estimated cost to live with host family + other living expenses)
TRANSPORTATION--------------------------------- $ 400 (monthly local bus pass for 9 months)
TOTAL $18,800
ENGLISH LANGUAGE INSTITUTE
Based on 2 sessions (4 months): 2012-2013
APPLICATION FEE----------------------------------- $ 50
TUITION/FEES*--------------------------------------$ 4,150 (cost for two 8-week sessions including instruction and fees)
TRANSPORTATION ---------------------------------$ 200 (monthly local bus pass for 4 months)
LIVING EXPENSES ---------------------------------- $ 4,400 (estimated cost to live with host family + other living expenses)
TOTAL $8,800
Fees for one eight-week session of the English Language Institute:
Instruction Insurance Student Services TOTAL
$1,670 $330 $35 $2,035
* All tuition and fees are subject to change without prior notification
DEPENDENT INFORMATION
Please complete the information below for a spouse or child planning to live with the international student. This
information is required to process a SEVIS I-20 form for an F-2 visa.
Name of Dependents
(as shown on Passport)
Relationship
to the
student
Gender
Date
of
Birth
Country of
Birth
Country of Citizenship
In order to bring a dependent to the United States, the F-1 visa student must provide additional evidence of financial support equal to
$1,000 per month for a spouse and $500 for each child.
RETURN TO:
International Office
MiraCosta College
One Barnard Drive
Oceanside, CA 92056
iip@miracosta.edu www.miracosta.edu/iip
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Completed 5 September 2020

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