INTERNATIONAL STUDENT FINANCIAL AFFIDAVIT FORM
READ CAREFULLY! You are required
to submit financial certification indicating you have documented support for the estimate of annual expenses.
If you plan to bring dependents (spouse and children), you must submit additional certification (see Part B). Do not include any anticipated
employment in the U.S. as part of your financial certification. Costs of higher education increase each year. Please review the Estimated Expenses
for a Single International Student.
PART A:
Your dependent (spouse and/or child/children) Information - $5,000 USD additional financial certification is required for
the first dependent and $3,000 USD for each dependent thereafter if
your dependents will accompany you
. Please complete
the following information for each dependent: Name Gender
Funding guaranteed for dependent(s) in USD (if applicable) Part A Total $
PART B:
FUNDING SOURCE(S)
Complete all that apply. Enter amount of assured support for the first year in U.S. Dollars. These funds, plus expected increases, are
expected to be available for each year of study in the U.S. by the student and/or sponsor.
Source of Funds Amount (in USD) Supporting Evidence
Student’s Personal Savings $
Bank Statement/Letter from bank on official bank letterhead
dated within the last six (6) months.
*Name on statement must match name of student
Name:
$
Bank Statement/Letter from bank on official bank letterhead
dated within the last six (6) months with sponsor’s full name
and address.
*Name on statement must match name of sponsor
Government Agency, Private Foundation,
University or Business
$
1. Official letter of support
2. Bank statements, affidavits,
or sworn statements
Scholarship or Loan:
Awarded by:
$
1. Official award letter
2. Loan approval letter
Total from Part A
(if applicable)
$ Passport copies
of dependents
TOTAL AMOUNT
$
(see the Expense Sheet)
PART C:
Original signatures are required to certify that the information provided on this form is complete and accurate to the best of your knowledge. By
signing this form, you are acknowledging that any false or misleading statements will result in an automatic denial of admission, or cancellation of
registration following enrollment.
Student’s Name: Signature: Date: _____
(Please legibly print Student’s full name)
Sponsor’s Name: _____________________________ __Signature:_______________________Date:_________________
(Please legibly print Sponsor’s full name)
Sponsor’s Relationship to Student: _______________________________
Remember: You must complete all application procedures, provide bank statements or scholarship award letters to document the
amounts listed, and be accepted by BSU before the I-20 form will be sent to you.
All application materials, including financial supporting documents become the property of Bemidji State University and
Relationship Date of BirthCountry of Birth
