Immigration Information Form
Office of International Admissions
Personal Information
First Name: ______________________
Last (Family) Name: ______________________
Middle Name: ______________________
PSU ID Number: ______________________
Country of Citizenship: ______________________
Country of Birth: ______________________
City of Birth: ______________________
Visa Status
If you are currently in the United States, provide
your current visa type: ______________________
If you DO NOT plan to maintain this visa type, list
the visa type you plan to use for the duration of
your studies at PSU: ______________________
If you are NOT currently in the United States, list
the visa type you plan to use to enter the United
States: ______________________
Current Mailing Address (required)
Address Line 1: ______________________
Address Line 2: ______________________
City: ______________________
State/Province/Territory (required for U.S. and
Canada): ______________________
Postal Code (required for U.S. and Canada):
Country: ______________________
Home Phone (include country code):
Personal/Permanent Address, Non-U.S.
Mailing Address (required)
Address Line 1: ______________________
Address Line 2: ______________________
City: ______________________
State/Province/Territory (required for U.S. and
Canada): ______________________
Postal Code (required for U.S. and Canada):
Country: ______________________
Home Phone (include country code):
Dependent Information
First Name
Last (Family
Legal Sex
Date of
Country of
Country of
City of
Child 1
Child 2
Child 3
Child 4
Child 5
Submit the Materials Listed Below with Financial & Immigration Information Form
1. Copy of Passport Photo Page for You and All Accompanying Dependents Listed Above
2. Statement of Support: If the name appearing on the financial documents is not the student, the following information must be
completed by person (sponsor) whose name appears on the documents. This statement of support can be one of the
a. A statement of support signed by your financial sponsor.
b. A letter from a sponsoring country, agency, or individual.
c. Completion of the lower half of the Statement of Support below.
3. Appropriate documentation: bank statement or letter showing enough money to cover the total estimated costs for
one year of living, tuition, and fees. The statement or letter must include all of the following:
a. Name of the bank
b. Office (branch) where the statement was issued
c. Specific contact information for the bank branch
d. Name of the account holder
e. Type of account (must be checking or savings account)
f. Amount in the account (in the currency in which it is held)
g. Date document was issued (must be issued no more than one year before the start of the first term of study {six
months for students transferring to PSU from another US-based institution])
h. If submitting a certificate of deposit or fixed account, the document must include a maturity date of no later than the
start date of your first academic term.
If you will reside with a sponsor in the Portland area, the sponsor is required to submit a salary statement from their employer on
business stationery which must include all of the information listed above and the following: dates and nature of employment, salary
earned, and whether the position is temporary or permanent. This can be used to show the ability of the sponsor to meet the living
expenses portion of the financial documentation.
We cannot use investment accounts, retirement accounts, statements of income, capability statements, solvency statements, certificate of deposit or
fixed account, educational loans, real estate holdings, estimated value of assets like gold or silver, or precious metals (gold or silver).
Funding Source Required Documentation Amount in
U.S. Dollars
Personal Funding Original bank statement
Family or Private Sponsor Original bank statement, plus Affidavit of Support section completed below.
University Support Students receiving graduate teaching or research assistantships (TA/RA) must have
their academic department submit a copy of the official letter of offer directly to the
Office of Admissions.
Government or
Agency Sponsor
Original official letter of Billing Authorization is required. Full disclosure of the extent,
amount and inclusive dates of government or agency support is necessary. The letter
must be addressed to Portland State University.
Other List specific details of other means of financial support. Private documentation of the
availability of funds is required.
Sources of Funding (required)
Document your sources of funding for your first year of study at Portland State University below. Check at least one source and provide appropriate
documentation along with this form.
Student Signature
I certify that all statements on this form are true and accurate and that the stated funds are available for my education expenses at
Portland State University. I will notify Portland State University of any changes in my financial situation. I understand that
misrepresentation of these documents may lead to disciplinary action.
Student Signature:__________________________________________ Date: ______________________
$ 0.00
Statement of Support
I certify that I am willing and able to provide a minimum of ______________________ (U.S. dollars) each year
for the educational expenses for ______________________ (student’s name). Official documentation of my
financial resources accompanies this Statement of Support. I will notify Portland State University immediately if
I discontinue financial support for this student.
Sponsor Signature: ____________________________________________ Date: ______________________
Printed Name of Sponsor: ____________________________________________
Relationship to Student: ______________________ Sponsor Email Address: ______________________
Sponsor Address: ____________________________________________
Sponsor Phone Number: ______________________