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FINANCIAL SUPPORT FORM - F1 Dependents
Instrucons:
1.Completestatement(printortype)andsign.Make sure to include all dependent's information.
2.
Includeyourspo
nsor’sinformaoninthespacesprovidedbelow.
3.Aachanyrequireddocumentaonshowingsourceoffunding(e.g.,cercaonleerfromabankonocialbankleerhead,bankstatement,
sponsorleer,etc.).Acco
mpanyingdocumentsmustbearoriginalsignatureorseal.Pleaserefertopage5formoreinformaon.
_______________________________________________________________________________________________________________________________________
LastNameFirstNameMiddleName
________________________________________________________________________________________________________________________________________
AddressTownorCity
______________________________________________________________________________________________________________________________________
ProvinceorStateCountryZipCode
Indicatebelowthenameofyoursponsor(s)andthesponsor(s)address.YouwillalsoneedtoindicatetheamountsandsourcesoffundsinU.
S.dollar
syouexpecttohave
availabletomeetthenecessaryexpenses.Aminimumof$23,850isrequired.Addionalfundsmustbeallowedforspouse(h usband/wife)orfamily(approximately$3,000
forspouseand$1,000foreachchildperyear).Theamountshownshouldbeincludedbelow.NOTE:
Ifyouhavemorethanonesponsor,pleasestatethenameandamount
providedbyeachsponsorseparately(submitasponsorshipleerfromeachsponsor).Pleaserefertopage5formoreinformaon.
NameofSponsor:
______________________________________________
RelaonshiptoStudent:
______________________________________________
Address:
______________________________________________
City:
______________________________________________
Country:
______________________________________________
Amount$________________________________
NameofSponsor:
______________________________________________
RelaonshiptoStudent::
______________________________________________
Address:
______________________________________________
City:
______________________________________________
Country:
_________________________________________
Amount$________________________________
NameofSponsor:
_________________________________________
RelaonshiptoStudent::
_________________________________________
Address:
_________________________________________
City:
_________________________________________
Country:
___
_____
_________________________________
Amount$________________________________
WillyourfamilyaccompanyyoutotheUnitedStates?_____Yes_____NoIf‘yes’howwilltheybesupported?
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Name:________________________________________________________________
DateofBirth:_______/_______/_______
RelaonshiptoStudent:__________________________________________________
PlaceofBirth:___________________________Cizenship:____________________
Name:________________________________________________________________
DateofBirth:_______/_______/_______
RelaonshiptoStudent:__________________________________________________
PlaceofBirth:___________________________Cizenship:____________________
Name:________________________________________________________________
DateofBirth:_______/_______/_______
RelaonshiptoStudent:__________________________________________________
PlaceofBirth:__
_________________________Cize
nship:____________________
Inthespacesbelow,pleaseprovidebiographicaldataoneachpersonaccompanyingyoutheUnitedStates.Pleaseaachanyaddionalinformaonif
necessary.
Iherebycerfythattheabovestatementsarecompleteandaccuratetothebestofmyknowl edge.Iamfullyawarethatanyfalseormisleadingstatementbymeormy
sponsor(s)canresultinadenialorcancellaonofadmission.
SignatureofApplicant
_______________________________________________________________________Date_________________________________
PrintedName
_____________________________________________________________________________
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