Updated 10/25/2019
Financial Information for J-1 International Exchange Students
Student Name: ____________________________________ _________________________________
Last/Family Name First/Given Name
Source o
f Funds: Check all that apply and enter the funding amount on the right.
Personal…………………………………………………………………………………..$____________
Submit an original bank statement dated within the last three months.
Family/Private Sponsor……….………..……………………………………………...$____________
Sponsor must complete the Affidavit below and submit an original bank statement dated within
the last three months.
S
cholarship…………...………………………………………………………………….$____________
Submit the original award letter or an official copy. Your name, exact amount awarded, and
duration of award must be listed in the letter.
Government Sponsor…….…………………………………………………………….$____________
Submit a letter on official letterhead from the sponsor that includes your name and date, and
details which costs (tuition, fees, housing, meals, etc.) will be provided.
TOTAL FUNDING……………………………………………………………………………...…..$____________
Amount must equal the total amount of estimated expenses for the academic year or semester. Cost
information will be provided to each student when they are nominated for study at MSU Denver.
I certify that the statements given by me in this form are complete and accurate. Additionally, if my source
of funding as listed above changes in any way, I understand that I remain responsible for all financial
obligations.
Student’s Signature __________________________________________ Date ___________________
Please note: A DS2019 cannot be issued without this form and the supporting documentation. If you
have more than one sponsor, each one must be identified and a separate Affidavit of Financial Support
must be submitted. Please keep copies of all financial documents, as you will need them to show proof of
funding to U.S. Consular officials when you apply for a visa and when you enter the United States.
Affidavit of Financial Support
(To be completed by financial sponsor/s)
I certify
that I will provide funds in the amount of at least U.S. $_____________, plus any increase due to
(amount)
inflation, per academic term for fees, books & supplies, room & board, insurance, etc. for the above-
named student. This support will continue for the duration of the student’s program of study at
Metropolitan State University of Denver.
Sponsor’s Name ________________________ Sponsor’s Signature __________________________
Sponsor’s Relationship to Student ______________________________ Date ___________________
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