XAVIER UNIVERSITY OF LOUISIANA
Office of Admissions * 1 Drexel Drive * New Orleans, Louisiana 70125 * (504) 520-7388
Web Page: www.xula.edu
International Student
Certificate of Financial Support
Name: _____________________________________ _____________________________ _____________________
Last (family) First Middle
Date of Birth (mm/dd/yyyy): _________________ City and Country of Birth:_________________________________
Immigration Status
Permanent Resident or Naturalized Citizen
Check One: Permanent Resident Naturalized Citizen
How long have you lived in the United States? _____ Months _____ Years
Present Mailing Address: ________________________________________________________________________
Address City State Zip
Please sign and submit a clear and legible copy of your supporting document (Green Card or Certificate of Naturalization)
Signature of Student:______________________________________ Date: _________________________
Non-Permanent Resident or Naturalized Citizen
Do you currently hold a Visa? Yes No
Current Visa Type:_________________ Registration Number: ____________ Date Issued: _____________
If “Other”, please specify: _________________________________________ Date Issued: _____________ Date Issued:
Permanent Address (Home Country): _________________________________________________________________
Address City Country
Certification of Finances for Non-Permanent Resident or Naturalized Citizens
The “Certificate of Financial Support” must be sworn to in person by the sponsor before a notary public, attorney, U.S. Consular
officer or other official authorized to administer oaths. Supporting evidence of financial resources must be attached to this
Certificate of Financial Support on official stationery from a bank or other financial institution in which the sponsor has savings
deposits, certificates of deposit, money market certificates or other types of accounts containing readily available funds. The
information should include (1) date accounts opened, and (2) specific amount of funds in the accounts in 86'ROODUV. This information
must be dated within 12 months of the intended date of enrollment and certified by a bank officer. 7+,6)250$1'$//
6833257,1*),1$1&,$/'2&80(1760867%(68%0,77('%<0$,/(0$,/('25)$;(''2&80(176
$5(127$&&(37$%/(
Personal Savings:
Account(s) holder name (s): _______________________________________________________________________
Sponsor(s):
Name: _________________________________ ____________________________ _____________________
Address: ____________________________________________________________________________________
Relationship to Applicant: ____________________________ Immigration Status (if in U. S.): ____________
Signature of Student: __________________________________ Date: ______________
Signature of Sponsor: _________________________________ Date: ______________
Signature of Notary: __________________________________ Date: ______________
SEAL
OF
NOTARY
