Certication of Finances
is form is NOT an application for nancial assistance. e U. S. Embassy and e Citizenship and Immigration Services requires you
to certify that sucient funds are available for your academic and living expenses for at least one academic year. Proof of funding may
include copies of bank statements or an ocial letter from a banking institution showing the amount of funds available. Emailed or
faxed copies of the form and proof of funding are accepted.
Although a decision on your application may be made without submitting the nancial documentation, we are unable to issue the
certicate of eligibility (Form I-20/DS-2019) without the nancial documentation. is form must be presented to the American
Consulate or embassy in your country in order to obtain an F-1/J-1 visa.
NAME OF STUDENT
Family First Middle
I understand that I am required by U.S. immigration law to provide Utica College with adequate documentation indicating that I have
sucient funds to cover my studies in the United States. I certify that the information on this form is true, correct, and complete.
Signature of Student Date
Please complete and submit the following information:
. F/S’ S: I am aware of the cost of an education at Utica College and I assume nancial responsibility for
the expenses of (print student’s name) ____________________________________________________________________________
Sponsor’s Signature ________________________________________________ Date ______________________________________
Sponsor’s Name ___________________________________________________ Relationship to Applicant _____________________
Sponsor’s Address _________________________________________________ Phone _____________________________________
Email ___________________________________________________________ Fax _______________________________________
. F S D
You must provide the following information showing the estimated cost of your program:
Submit a letter from your bank or bank statements stating that you or your sponsor have sucient funds to support your costs at Utica
College. e nancial documents must be dated within six months of application submission to be considered valid. Each individual
contributing nancially to your education must complete this form and submit an ocial dated bank statement. In case of jointly held
accounts, each individual holder must complete this form.
If applying for the issuance of a DS-2019, a detailed letter on department letterhead indicating the dollar amount and dates of the
award. If a stipend is included, the exact amount must be specied. If possible, itemize amounts of tuition, living expenses, health
insurance, etc. provided in the award. If receiving nancial support from an employer, government agency or organization, a detailed
letter from the sponsor indicating the exact dollar amount being provided, in U.S. funds. is letter must be on ocial letterhead and
include the dates of sponsorship.
1600 Burrstone Road, Utica, New York 13502-4892 • Voice: 315.792.3082 • Fax:315.792.3061
www.utica.edu • firstname.lastname@example.org