CLARKSON UNIVERSITY
I
NTERNATIONAL
S
TUDENT
C
ERTIFICATION OF
F
INANCES
U
NDERGRADUATE
A
DMISSIONS
1 | Page
All International applicants must sufficiently document their ability to meet all tuition and living expenses associated with their
intended degree program. These expenses include – but are not limited to – tuition & fees, books, supplies, living expenses
and insurance for themselves and any dependents. All information below is required before a Certificate of Eligibility (Form I-
20 or DS-2019) will be issued.
Instructions for this form: Section I Answer all biographical information completely
Section II Review estimated* expenses for one academic year (summer not included).
Section III - Indicate if dependent documents needed (if applicable)
Section IV – Indicate your sources of funding and the amount available to you each year.
Section V – Affidavit of support – verify and sign funding requirements
SECTION I – STUDENT BIOGRAPHICAL INFORMATION (Please provide a copy of your passport)
Note: It is very important that your name appears exactly as it appears in your passport – if your passport lists no ‘Surname’ or ‘Given
Name’ – write a ‘---‘. NOTE: Please either type or print in neat block letters.
CU ID: E-mail Address: CU Major:
Please indicate form requested (please check all that apply)
I am currently in the United States (Please complete the ‘International Student Transfer Form’ along w/ this form)
If you checked you are currently in the United States – please indicate your current immigration status (i.e. F1/J1/B1)
Visa Type Current Status Expiration
I-20 for F-1 Student Visa
DS-2019 for J-1 Student Visa
(Must be supported substantially by funding for any source other than personal or family funds – OR
– through an Exchange Agreement with Clarkson University)
Last/Family Name First/Given Name(s)
Gender Male Female Date of Birth
(mm/dd/yyyy)
City of Birth Country of Birth
Country of Citizenship
Country of Legal Permanent Residence
SECTION II – ESTIMATED EXPENSES
Following are estimated costs for full-time attendance at Clarkson
University. It is necessary that you pay your own travel expenses to and from Potsdam, New York. You are required to certify
that you will have the total amount equal to or greater than the estimated amount listed below and barring unforeseen
circumstances, adequate funding will be available from the same or equally dependable source for subsequent years in
attendance. *Costs are subject to change each year*
Tuition – Fall/Spring
Fees
Rent & Food (Room & Board)*
Books*
Clothing, Recreation, Miscellaneous*
Total
*Actual costs may vary according to your program or personal preferences
SECTION III – DEPENDENT SUPPORT –
A student that will be accompanied by your spouse and/or children while
studying at Clarkson University, you are required to demonstrate your financial ability to support them during their stay.
Clarkson University estimates the additional cost of bringing a dependent is approximately $3,000 for your spouse and $1,500
for each dependent child. Please provide the following information and provide a passport copy for each dependent.
Number of Dependent Documents Requested
Spouse Children
Name of Spouse (Last, First) Child 1 Name (Last, First) Child 2 Name (Last, First)
Undergraduate/Transfer Admission
$ 46,700
$ 1,250
$ 14,794
$ 1,432
$ 3,168
$ 67,344
CLARKSON UNIVERSITY
I
NTERNATIONAL
S
TUDENT
C
ERTIFICATION OF
F
INANCES
U
NDERGRADUATE
A
DMISSIONS
2 | Page
SECTION IV – SOURCE OF FUNDING AND REQUIRED DOCUMENTATION
Please specify all sources
of support to finance your education. You and your sponsor must sign the verification statements below indicating that you are
responsible for all costs.
Check the appropriate source of funding (multiple sources are acceptable) and attach appropriate financial documentation for
each showing availability of at least the total of your estimated expenses for the first year and barring any unforeseen
circumstances – the funding will be available for each additional year of study.
Please note –
Bank statements carry no liability to the bank.
All documents must be dated within one year of initial enrollment and translated into U.S. dollars
This information is required for visa eligibility
Clarkson University reserves the right to require additional financial documentation as necessary
Note: Real estate holdings – salary verification letters – retirement funds – stocks/bonds – life
insurance policies are not acceptable.
Required Documentation Types of Funding
Amount
Available
Official letter or statement – signed and dated – from a bank
official or financial institution. Must be no more than 6 months
old and shows a current balance sufficient to cover funds
needed (as shown on page 1)
Personal Savings
Name of
Bank_______________________
$
Official letter or statement – signed and dated – from your
sponsor’s bank or financial institution indicating a current
balance to cover the funds needed (as shown above). Funds
must be in the form of liquid assets, i.e. cash or assets that
can easily be converted into cash (checking or savings
accounts).
Sponsor (i.e. parents – relative -friend)
Note: This person is to complete the
sponsor statement below
$
A copy the financial aid award letter
(provided by admissions)
Clarkson Financial Aid/Scholarship
$
Official letter indicating amount of support. Letter must
include full name – amount of money available for each year
of study – duration of the award – and – institution to which
award is applicable.
Government/Company
$
Official letter indicating amount of support. Letter must
include full name – amount of money available for each year
of study – duration of the award/loan – and – institution to
which award is applicable.
Other scholarships or student loans
Other support _____________________
$
Total Funding
=$________
SECTION IV – AFFIDAVIT OF SUPPORT –
By completing this affidavit, you are verifying to the U.S. government that you
will provide this student with a specific amount of money (as stated above) for each year he or she is studying at Clarkson University. You
are also proving that you can afford this support from the documents you have attached.
Sponsor Certification
:
This is to certify that I (we) the undersigned have read the information on this form and find it to be
true and accurate. I (we) agree to provide the funds required for all years of study at Clarkson University and that I (we) are
submitting bank statements indicating the availability of funds.
Parent/Sponsor Name (please print) Relationship
Parent/Sponsor Signature Date
Student Verification
:
This is to certify that the information given on this form is complete and accurate to the best of my
knowledge. I am fully aware that any false or misleading statement will result in denial of my admission to Clarkson University or
in cancellation of my registration following enrollment.
Student Signature Date
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