Certification of Financial Responsibility (CFR)
Student Information
UT Tyler ID Family/Surname Given Name Admission Semester
Date of Birth (mm/dd/yy) City of Birth Country of Birth Country of Citizenship
Dependent Information
A spouse or an unmarried child up to 21 years old may qualify as your dependent while you are at UT Tyler. A passport and marriage
license (if applicable) must be submitted. Your financial documents must demonstrate enough funding for yourself and any dependents (+
$5000 for your spouse, + $3000 for each child). List and attach additional dependent information.
Family/Surname, Given Name Date of Birth
Country of Birth Country of Citizenship
Gender Relationship to you
Family/Surname, Given Name Date of Birth
Country of Birth Country of Citizenship
Gender Relationship to you
Financial Responsibility
Review the tables below to determine the amount you or your sponsor must demonstrate. The figures below are estimates used for the
purposes of issuing an I-20. The estimates below include tuition & fees, living expenses, and mandatory health insurance. International
students requesting an I-20 must prove financial responsibility. The amounts are based on UT Tyler's Cost of Attendance tables.
Select Program Type Non-Resident Resident
Undergraduate
$40,399 $25,809
Graduate $32,179 $23,479
Pharmacy (rate is the same for non-residents and residents) $51,307
Intensive English Language Institute (rate is the same for non-residents and residents) $21,796
Qualifying Scholarship Deductions
Deduct the total amount required from any UT Tyler Scholarship you have received. If you receive a competitive
scholarship from UT Tyler in the amount of $1,000 or more, you qualify to pay resident tuition and fees. You must
submit proof of your scholarship award along with your CFR or email a copy to oip@uttyler.edu.
Attach here
Current Immigration Status
Do you currently have an F-1 Visa? Name of Institution I-20 Expiration Date
Yes No
Document Attachments
Attach passport data page Attach financial documents
Student Certification of Responsibility
I certify that the information provided in this form is accurate and I understand I am responsible for all costs related to my studies at UT Tyler.
Name Signature Date
-Select-
-Select-
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FINANCIAL DOCUMENT REQUIREMENTS
Financial documents must be in English and must bear a signature, official seal,
or be on letterhead from on official agency.
Documents must be dated within 6 months of submission.
A completed Certification of Financial Responsibility must accompany each
financial document submission.
If the student is using personal funds, the student must complete the CFR through
the Student Certification section.
Sponsor(s) name must be listed on the submitted bank statement
If the funds are provided by anyone else, the person whose name is on the
submitted bank statement must sign the Sponsor Responsibility section.
FINANCIAL SUPPORT SOURCE(S) - Attach, forward, or scan applicable documents
Personal and/or family savings
o Bank letter/statement which clearly shows the name of the
account
owner. Required if the applicant will be supported in whole or in part by
personal or family funds.
Assistantship/Fellowship/Scholarship from UT Tyler
o Award letter or email notice from the Admissions office, Graduate School,
or Academic Department
Government/Other Sponsor
o Print organization name and attach signed copy of letter certifying your
sponsorship award and award dates of validity
Other: If not listed, attach it for consideration.
Student Information
UT Tyler ID Family/Surname Given Name Admission Semester
Select Program Type Non-Resident Resident
Undergraduate
$40,399 $25,809
Graduate $32,179 $23,479
Pharmacy (rate is the same for non-residents and residents) $51,307
Intensive English Language Institute (rate is the same for non-residents and residents) $21,796
Sponsor Certification of Responsibility
A signature is required from the person who will financially support you. The name of the sponsor listed must match the bank statement(s)
submitted.
By signing below, I certify that I will financially support the student mentioned on this application for all educational, living, health, and
personal expenses until completion of their degree at The University of Texas at Tyler.
Name
Relationship to
Student
Signature
Date
-Select-
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