Fillable INTERNATIONAL STUDENT CERTIFICATION OF FINANCES

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INTERNATIONAL STUDENT CERTIFICATION OF FINANCES

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INTERNATIONAL STUDENT
CERTIFICATION OF FINANCES
2021-22
The purpose of the Certication of Finances is to help colleges and universities obtain complete and accurate information about the
funds available to international applicants who want to study in the United States. Strict government regulations, rising education costs,
and economic conditions have made verifying the nancial resources of international applicants essential. Institutions do not have the
option of deciding whether to verify the nancial resources of their international applicants; nancial verication must be made prior to
institutional issuance of a Certicate of Eligibility (Form I-20 or DS-2019).
This form is designed to standardize nancial information provided by applicants to colleges, universities, and U.S. consuls.
By completing this form and returning it to the college or university requiring it, an applicant, if admitted, may obtain that college’s
authorization and issuance of a Certicate of Eligibility (Form I-20 or DS-2019). If parents and/or sponsors are unable to obtain a bank
ofcial’s verication, it is recommended that institutions forward a copy of the International Student Financial Aid Application to the
family for completion. The institution should attach a copy of this certication to the Certicate of Eligibility. U.S. consuls scrutinize the
statements of nancial resources given by nonimmigrant visa applicants. This certication will help such ofcials make their decisions
and expedite visa issuance.
Return directly to the college providing or requesting this statement.
The space below is for optional use by issuing institutions for listing student’s expected annual budget.
1. Your Name
Mr. Ms. Mrs. Miss
Family (surname) Given (first) Middle
2. Permanent Address
3. Mailing Address (if different from above)
4. Date of Birth
Month Day Year
5. Place of Birth (country)
6. Country of Citizenship
7. Expected Visa Type
F-1
F-2
J-1
J-2
G-1
G-2
G-3
G-4
H
Other (specify) _____________________________
1
8. Enter the expected amount of annual support from the sources listed below. Enter amounts in U.S. dollars. Please PRINT all entries.
Use an additional sheet of paper for explanations, if necessary.
Student’s Sources of Funds
Assured
Support
Projected
Support
8a. Personal or Family Savings
Name of Bank
2021-22
$ .00
2022-23
$ .00
2023-24
$ .00
2024-25
$ .00
Signature of Bank Official Date
Title
Name of Bank
Address of Bank
Ofcial Certication of Sources of Funds and Amounts
This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
8b. Parents (Money available from sources other than savings.)
Parent’s Name
$ .00
$ .00
$ .00
$
.00
Relationship
Parent’s Name
$ .00
$ .00
$ .00
$
.00
Relationship
Please describe the source:
Signature of Parent Date
Address
Ofcial Certication of Sources of Funds and Amounts
This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
8c. Sponsors (Money available from sources other than parents.)
Sponsor’s Name
$ .00
$ .00
$ .00
$
.00
Sponsor’s Name
$ .00
$ .00
$ .00
$
.00
Please describe the source:
Signature of Sponsor
Date
Address
Relationship of Sponsor to Student
Ofcial Certication of Sources of Funds and Amounts
This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
8d. Your Government
Name of Agency
Enclose a signed copy of your letter of award with this form.
$ .00
$ .00
$ .00
$
.00
TOTAL
$ .00
$ .00
$ .00
$
.00
2
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9. What is the present exchange rate of your country’s
currency to the U.S. dollar?
(for example, 3,100 pesos = $1)
_______________________ = $1
10. Does your government currently impose restrictions on exchange
and release of funds for study in the U.S.?
Ye s
No
If YES, describe restrictions.
11. D o you have a source for emergency funds once you arrive
in the U.S.?
Ye s
No
If YES, name source.
Amount available in U.S. dollars
$ .00
12. How will you pay for your transportation to the U.S.?
13. What is the total amount of money
you expect to have when
you arrive at this institution?
$ .00
14. Do you plan to remain in the U.S. during the summer?
Ye s
No
15. If remaining in the U.S., do you plan to attend
summer school?
Ye s
No
16. What are the sources and amounts of support
available to you during the summer?
Sources Amount
U.S. $ .00
U.S. $ .00
U.S. $ .00
U.S. $ .00
17. A CERTIFICATE OF ELIGIBILITY (Form
I-20 or DS-2019) will not be authorized
until this form is completed and
returned to the institution to which
you are applying. The institution will
attach a copy of this form to your
CERTIFICATE OF ELIGIBILITY. Both the
form and certi cate must be shown to
the U.S. consul to obtain a visa.
Signature of Student _________________________________________________________________________________
I certify that the information on this form is true, correct, and complete.
I understand that any misrepresentation may be cause for refusing or
revoking admission.
Date
Day Month Year
This is to certify that I have reviewed
the
declaration and attached documents, if
appropriate, and approve issuance of a
Certificate
of Eligibility.
FOR OFFICE USE ONLY
SIGNATURE OF
COLLEGE OFFICIAL __________________________________________________________ TITLE ___________________________________________
NAME OF INSTITUTION ________________________________________________________________________________________________________
ADDRESS________________________________________________________________________________________________ _______________
3
DATE
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INTERNATIONAL STUDENT CERTIFICATION OF FINANCES

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Completed 21 December 2020

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