Request for Form I-20 & Certiﬁcate of Finances
International Students 2020 - 2021
Section I. Personal Information
(Student must complete all sections, unless exempted from speciﬁc items listed below.)
In what subject area do you plan to study/major? This information is required and will appear on your I-20. In addition, consular
oﬃcials may inquire about your course of study, so be sure that it accurately reﬂects your academic interests (i.e., Computer Science,
Business Analytics, Mechanical Engineering, etc.).
If you are currently in the U.S., what is your visa status? Please indicate whether it is an F1, H4, R2 or any other type of non-
*Students studying in the U.S. must submit photocopies of current I-20 and I-94 documents with their application form.
Section II. Address Information
Permanent Address. Your permanent address must be a non-U.S. address in order for an I-20 to be issued to you. If you are currently
living in the U.S., you must provide the address of a relative or friend abroad who will be able to retrieve your documents if necessary.
Mailing address. Only complete this if you want your documents to be sent to an address other than your permanent address.
Issuance of documents. Form I-20 will be mailed ﬁrst-class, air mail. If you prefer to have documents mailed via courier service (DHL,
UPS, FedEx, etc.), you must request special handling from the Admissions Oﬃce via e-mail at: email@example.com
You must also
provide billing information as you are solely responsible for all fees associated with this service.
Section III. Source and Amount of Funding
According to USCIS regulations, the international student advisor is required to receive and evaluate evidence of ﬁnancial support to verify
that students will be able to suﬃciently cover the costs of their education. Original documents or certiﬁed copies/letters must be provided by
banks, sponsoring agencies, etc., as necessary, to conﬁrm funding sources. The amounts provided must be equal to or greater than the
estimated total cost of attendance for 2018-2019 ($39,199 for undergraduates and $38,192 for graduates).
Source of Funds for 2020 - 2024. You must provide exact amounts for the academic year 2020 - 2021. For each subsequent year
(2021 – 2022, 2022-2023, and 2023-2024), provide an estimate of the projected funds you plan to receive. Therefore, if you anticipate
the amount of ﬁnancial aid, family income, etc., to remain relatively the same, you may duplicate those amounts in the appropriate
Florida Polytechnic University Financial Aid. You must provide a copy of your Financial Aid award letter.
Your Personal Funds. You must provide a bank statement or certiﬁed letter (with an English translation, as necessary) for any income
earned from employment, etc., that will be applied to the costs of your education. While it is likely that the bank statement will ﬂuctuate,
please provide as accurate information as possible. For example, if you intend to provide $3,000 and your bank statement indicates a balance
of $1,000, that is to be expected. We need to ensure that there is a pattern of assets being set aside for the purpose of funding your education.
The amount that you provide on this form should be the amount you plan to have available at the time you travel to the U.S. to pursue your
studies. You will have the opportunity to declare any dependents that will accompany you.
Family/Relative Funds. You must provide a bank statement or certiﬁed letter indicating the amount of funds that your family members
plan to apply to the costs of your education. While it is likely that the bank statement will ﬂuctuate, please provide as accurate information as
possible. For example, if you intend to provide $3,000 and your bank statement indicates a balance of $1,000, that is to be expected. We need
to ensure that there is a pattern of assets being set aside for the purpose of funding your education. The amount that you provide on this form
should be the amount you plan to have available at the time you travel to the U.S. to pursue your studies.
Government or Sponsoring Agency. If you will receive any money (scholarships, grants) in addition to, or in place of, the funding
sources listed above, you must provide the oﬃcial letter(s) of support/award, along with the amount.
Other. Any other funds being provided that do not apply to any of the previous sections should be listed here (stocks, etc.).
Sections IV & V. Veriﬁcation & Student Signature
Signatures are required for any person(s) providing funds, as well as for the student submitting the application.