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BROWSE MILLERSVILLE UNIVERSITY OF PENNSYLVANIA FORMS

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Phone: 717-871-7506 | International@Millersville.edu | www.
millersville.edu/internationalprograms/
P.O. Box 1002, Millersville, PA 17551
SOURCES OF FUNDS FORM
This document is to certify the availability of funds to cover the estimated expenses (including dependents) for the first year. All F1 and J1 international
applicants must document their ability to meet all educational and living expenses for the first year of intended study before the issuing of immigration
documents (form I-20 or DS-2019).
See below for estimated expenses for programs. Submission of the international student Source of Funds Form and official financial proof verifying the
required total is necessary to receive immigration documents from Millersville University.
Please allow one week for processing. Failure to follow instructions may result in a delay in processing your immigration document.
Last Name (Family Name)
First Name (Given Name)
Gender
Male Female
City and Country of Birth
Country of Citizenship
Date of Birth (month/day/year)
Country of Legal Permanent Residence
Current Occupation
Proposed Term of Admission
Fall (September) Spring (January) Summer (English Language Institute)
Major
Email Address
Millersville University ID # (if known)
If currently in the U.S., indicate your visa type: _________.
If you currently have an F-1 or J-1 visa, you must attach a copy of your most recent I-20 or DS-2019, passport, visa, and printed I-94 number.
MAILING ADDRESS
List where you would like your immigration documents sent to.
Name/Recipient
Address
City
Postal Code
Telephone #
ESTIMATED EXPENSES
UNDERGRADUATE (30 Credits)
GRADUATE (18 Credits)
J-1 EXCHANGE
ENGLISH LANGUAGE INSTITUTE
TUITION AND FEES
$22,822
$20,124
-
$10,898
LIVING EXPENSES
$14,106
$14,106
Up to $14,106
$14,106
HEALTH INSURANCE
$1,000
$1,000
$1,000
$1,000
BOOKS & MISCELLANEOUS
$1,400
$1,400
$1,400
$600
TOTAL
$39,328
$36,630
$2,400- $16,506
$26,604
TUITION AND FE
ES ARE BASED ON TAKING UP TO 15 CREDITS PER SEMESTER FOR UNDERGRADUATE AND 9 CREDITS FOR GRADUATE
PROGRAMS AND 20 CONTACT HOURS FOR THE ENGLISH LANGUAGE INSTITUTE. COSTS ARE LISTED PER THE 2019-2020 ACADEMIC YEAR.
Note: Transportation costs to and from the U.S. are not included. In addition to the above estimated costs, allowances must be made for educational and related expenses.
Estimates for tuition, books, living expenses, and miscellaneous expenses for optional Winter and Summer terms are not included. Costs are subject to change. Living
expenses include shared-room and meal plan. Students can choose other room and meal plan options.
Exchange students required to live on campus do not pay room and board fees to study at Millersville. If you were given the option to live on or off campus as an
exchange student, you must show proof of funds for living expenses.
DEPENDENTS:
Living expenses and health insurance for spouse: $6,000
Living expenses and health insurance for each child: $4,000
HEALTH INSURANCE IS REQUIRED FOR ALL F-1 AND J-1 VISA STUDENTS AND DEPENDENTS.
Millersville University | Office of International Programs and Services | P.O. Box 1002, Millersville, PA
17551 Phone: 717-871-7506 | international@millersville.edu | www.millersville.edu/internationalprograms/
(Form Updated 04/22/2019)
SPONSOR SECTION
First Name
Last Name
Source of Funds
Required Documentation
US Dollar Amount of Funds
Personal
Official and original dated documents must be provided. All documents must be in English.
All supporting documentation must be dated within one year of initial enrollment
$
Family/Relative(s)/Another
Individual Sponsor
Official and original dated documents must be provided. All documents must be in English.
All supporting documentation must be dated within one year of initial enrollment
$
Government/Employer/Other
Organization Sponsor
Submit a sponsor letter including amount for tuition/fees, living expenses, books and supplies,
and health insurance each year. The letter must include 1) Name of applicant, 2) Amount of
money available for each year of study, 3) Duration of award (start and end dates), and 4) Degree
and major field of study for which award is tenable
$
Loans
Official letter from credit institution indicating approval of loan and the amount approved
$
TOTAL
$
N
ote: Complete and attach the appropriate documentation required. All documentation must be dated within 6 months of the date of initial enrollment at Millersville
University. Funds should be cash assets such as cash in a savings account, stocks or bonds, short- term annuities or certificates of deposit with expiration date indicated. Cash
assets must be verified by submitting bank statements or similar statements showing specific amounts. If funds are in a currency other than US dollars, we will do the
conversion.
DEPENDENT SECTION
Note: Dependents can only be spouse and child. You must submit copies of each dependent’s passport for the immigration documents.
Dependent’s Name (First, Last)
Relationship to
Student
Birth Date
(MM/DD/YYYY)
City and Country of
Birth
Country of Citizenship
READ THE STATEMENT BELOW AND SIGN
For verification that funding is available, I have attached an original bank statement(s) or letter(s). I will provide (check one):
full financial support
partial financial support per year for the applicant’s (and dependents, if applicable) tuition, fees, and living expenses for the entire length of study
at Millersville University.
_____________________________________________ ___________________________________________
Sponsor’s signature Date (month/day/year)
I
certify that the information given on this form is complete and accurate to the best of my knowledge. I am fully aware that any false or
misleading statement(s) will result in an automatic denial of admission or cancellation of registration following enrollment.
Millersville University reserves the right to require additional financial documentation and/or prepayment from applicants whose countries
impose currency exchange restrictions or other obstacles to the transfer or currency. Applicants from such countries will be notified of specific
requirements when they have submitted complete applications.
I understand I am ultimately responsible for all anticipated yearly expenses for the length of my stay at MU. I understand that these documents
will not be returned to me.
_____________________________________________ ___________________________________________
Student’s signature Date (month/day/year)
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Completed 23 August 2020

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