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International Student
Statement of Financial Support and Responsibility
2020
Part I: Students Information
1. First/Given Name
2. Middle Name
3. Last Name
4. Date of Birth (DD/MM/YYYY)
5. Home Address
6. Home City
7. Zip/Postal Code
8. Home Country
9. Phone Number (include country code)
10. Email Address
11. Gender (select one): Male Female Other Prefer Not to Answer
12. Country of Birth ________________________________________
13. Country of Citizenship ____________________________________
14. Marital Status (select one): Single
Married
Divorced/Widowed
15. If Married/Divorced/Widowed, how many people are financially dependent on you?
What is their relationship to you?
________________________________________________________________
________________________________________________________________
16. What year and term do you plan on enrolling at Newberry? __________________
17. What program of study do you wish to pursue? ___________________________
18. Are you a student athlete? Y N If yes, what sport? ____________________
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Part II: Family Information
1. What is your parents’ current marital status? (Circle One)
Married Separated Divorced Father Deceased Mother Deceased Other
2. Parent Information
Father’s Name___________________________________________________________
Father’s Address _________________________________________________________
Fathers Email Address _____________________________________________________
Fathers Phone Number (with country and area code) ________________________________
Father’s Occupation/Employer ________________________________________________
Mother’s Name___________________________________________________________
Mother’s Address _________________________________________________________
Mothers Email Address_____________________________________________________
Mothers Phone Number (with country and area code)________________________________
Mother’s Occupation/Employer_______________________________________________
3. How many people, including yourself, depend on the income of your parents for
daily living expenses? _______________
4. Family Listing: Provide information for ALL family members you included in
question 3 (Do NOT provide information about yourself below)
Name
Age
Relationship
to you
School Name
Year in
School
Tuition
and fees
Room
and
Board
Amount
Parents
Pay per
Year
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Part III: Financial Information
How will you pay for your transportation to the United States? _________________
Do you have a source of emergency funds once you arrive in the U.S.? (Y/N)
If yes, name source: _____________________________________
Amount available in U.S. $________
1. Income and Assets: During the past year, how much of your household income (before taxes
or expenses) came from the following sources? (NOTE: All values should be in U.S. dollars)
Father’s work: $________
Mother’s work: $________
Your work: $________
Your spouse’s work: $________
Family Business: $________
Family real estate holdings: $________
Pension/Annuity/Retirement: $________
Other members of the household: $________
Interest or dividends: $________
Housing, food, and other living allowances: $________
Other: $________
(Please explain: ____________________________________________)
Please list the value of the following family assets below (if applicable).
Land and Buildings (other than home or business): $________
Savings: $________
Money in another country: $________
Assets in another country: $________
Assets owned by students: $________
Investments (stocks/bonds): $________
Property in another country: $________
2. Annual Expenses
Please list the amount your family spent on the following expenses during the past year (specific
amounts are needed).
Note: All values should be in U.S. dollars.
Rent or mortgage: $________
Food: $________
Medical expenses: $________
Loan payments: $________
Insurance (health and property): $________
Utilities: $________
Household necessities: $________
Education expenses for siblings: $________
Taxes: $________
Other: $________
(please explain________________________________________________________)
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Part VI: Special Circumstances
Please indicate in the provided space any unusual expenses, other debts, or special circumstances that
the institution may need to take into consideration, or any anticipated significant increase or decrease
in your family’s income next year?
_____________________________________________________________________
_____________________________________________________________________
Part VII: Student’s Expected Support for Educational Expenses
In the space below, enter the amount of expected annual support toward your educational expenses
from the sources listed below. (For example, if you plan on paying from income, and your expected
out of pocket cost is $15,000/year, you will put $15,000 in the Familys Income line below for each
year, 1
st
-4
th
.)
NOTE: All values should be in U.S. dollars.
1
st
year
2
nd
year
3
rd
year
4
th
year
Newberry
College
Scholarships
Family income
Family assets
Student assets
Relatives &
friends
Agencies &
foundations
Private
Sponsors
Your
Government
Other
NOTE: Please provide any necessary supporting documentation to verify income and asset
information requested on this form, such as a bank letter, statement of employment, letter from
sponsors/agencies, etc.
Explain external sources of funding (agencies, foundations, private sponsor, government, and/or
other):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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Part VIII: Certification and Authorization
The financial information you provided will be used in order to issue all necessary documentation for
the processing of your visa. Federal regulations require us to have on file financial documentation for
international students in order to certify that you and your family are able to provide sufficient
financial support towards the entire Cost of Attendance for every year you are enrolled at Newberry
College.
The Cost of Attendance is defined as the Direct Costs payable to Newberry College (these include
tuition, fees, room, board) combined with any additional costs that are not directly payable to the
College, but you should anticipate as expenses: transportation, books, personal expenses, health
insurance, etc.
Please note that the costs for tuition, fees, room and board may increase year over year, so you can
anticipate seeing a 2-4% increase in direct costs.
Academic Year 2020-2021 Costs:
Tuition: $25,650
Fees: $2,500
Room:
Board:
Total Direct Costs: $39,450
Estimated additional costs:
Total Cost of Attendance: $45,500
By submitting the Newberry College International Student Statement of Financial Responsibility
and Support, we declare that the information on this form is true, correct, and complete. The College
has our permission to verify the information reported by obtaining documentation as needed. We
understand that providing false information could result in Newberry College revoking its initial
decision to enroll a student. We understand that each semesters bill is due to be paid in full prior to
the start of the semester. Failure to pay the bill in full could result in non-matriculation.
Student’s Signature: ___________________________________ Date: ________________
Parent’s/Guardian’s Signature:____________________________ Date: ________________
Parent’s/Guardian’s Signature: ____________________________Date: ________________
$5,950
$5,350
$6,050
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