DECLARATION OF FINANCES 2021-22
confidential
RETURN TO:
International Admissions
St. Ambrose University
518 W. Locust St.
Davenport, IA 52803 USA
Fax: 563-333-6243
international@sau.edu
www.sau.edu/international
International student admission for F-1 and J-1 visa holders cannot be finalized (nor can your immigration document be issued) until
this
completed form and supporting financial documentation are returned to St. Ambrose University.
Student Information
Name
Last/Family First/Given Middle
Mailing Address
Phone Number
Email Address
Sources of Funds
Estimated Cost (tuition, room & board, books, health insurance, personal)
$
This estimate is for the first year only. For subsequent years, expect tuition increases due to inflation and cost of living increases.
St. Ambrose University Scholarship
$
Total Proof of Funding Student Needs
$
Please show your funding sources below.
Enter amounts in US dollars. Please PRINT all entries.
Use an additional sheet of paper for explanation if necessary.
Personal or Family Savings
$
Assured Support
First Year
Name of Bank
Enclose with this form a supporting letter signed by a bank official or a current bank statement.
Parents and/or Sponsors
Name
$
Name
$
Enclose with this form a supporting letter signed by a bank official or a current bank statement.
Your Government or other agency
$
Name of Agency
Enclose with this form a signed copy of your award letter.
$
Name of Agency
Enclose with this form a signed copy of your award letter.
Total Proof of Funding
Student Needs
This total should equal the Total Proof of Funding
Student Needs for one year
TOTAL
$ =
$
I certify that
the information
provided here
is correct and
complete.
Signature of Student
Date
Please Save & Email this Document along with supporting
financial documents to international@sau.edu
Cost of Attending details
Dependents
Spouse: $6,000 per year
Child: $4,800 per year
