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To be used by students financially dependent on (Ohio State University, Columbus)

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  • 11 check-boxes
  • 43 other fields

Country of origin: US
File type: PDF

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OFFICE OF INTERNATIONAL AFFAIRS
To be used by students financially dependent on the support of others.
If you need a new I-20 or DS-2019, Ohio State is required by the U.S. Government regulations to
determine whether you have adequate funding for tuition, fees and living expenses for the duration of your
stay. ISS will be unable to process your request for a new I-20 or DS-2019 until funding documentation is
complete.
Documentation of Funds
Complete both sides of this form and provide documentation as required. All documentation of sources of
support that you submit must:
• Include the sponsor’s name
• Be dated within the last 12 months; and
• Be written in English
Affidavit of Support
A separate affidavit is required for each sponsor. The total funds on the affidavit(s) must equal the total
estimated expenses indicated below.
Bank Statement
Each personal sponsor (friends or family) must provide a statement or letter from the bank showing U.S.
dollars or type of currency where the account is held totaling the amount needed. The sponsor on the
Affidavit of Financial Support and the account holder on the official bank statement must be the same.
Estimated Expenses
$ ____________
This amount represents an estimate of expenses associated with continuing your program of study at
Ohio State.
Student Information
Last Name: __________________________________________________________________________
First Name: __________________________________________________________________________
Middle Name: _________________________________________________________________________
Date of Birth (mm/dd/yyyy): _____/_____/________ Ohio State Email:___ _________________________
Country of Birth: ________________________________ City of Birth: ____________________________
Country of Residence: _______________________ Country of Citizenship: ________________________
Current Status:
q F-1 q J-1 q Other: ___________
INTERNATIONAL STUDENTS
Affidavit of Financial Support
Student’s Declaration
I, ________________________________________ (applicant’s printed name), hereby promise that the
information provided is correct and complete. I understand that I am ultimately responsible for all
expenses associated with my stay in the United States.
Signature of Applicant: ________________________________ Date (mm/dd/yyyy): ____/____/________
!
Affidavit of Support from Personal Sources (family or friends)
Directions: Ask your personal sponsor(s) to complete the appropriate sections below. A separate affidavit
is required for each sponsor. The sponsor and the account holder on the official bank statement must be
the same.
Check all that apply:
q I will provide full financial support for the applicant’s educational and living expenses for the
entire length of study at Ohio State. As verification that funding is available, I have attached one or
multiple bank statements.
q I will provide partial financial support. Amount per year: $_______________
Duration of Support:
q All Study Years
q 1
st
Year
q 2
nd
Year
q 3
rd
Year
q Other: _______
As verification that funding is available, I have attached one or multiple bank statements.
q I will provide full support for spouse and/or children if accompanying applicant to the United States.
As verification that funding is available, I have attached one or multiple bank statements.
Personal Sponsor
Name: _________________________________ Relationship to Student: _________________________
Address: ____________________________________________________________________________
Signature of Sponsor: _________________________________ Date (mm/dd/yyyy): ____/____/________
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Affidavit of Support from Funding Agency (government, organization or institution/school)
Directions: Please ask your funding agency to complete the following.
We, ______________________________________ (name of sponsor), hereby certify that we will pay the
following expenses associated with tuition, fees, books, health insurance and living expenses for
______________________________ (student) and, if applicable, health insurance and living expenses
for spouse and children.
Study is approved for ___________________________ (degree) in _____________________________
(field of study) at The Ohio State University. Funding is effective from ____/________ (mm/yyyy) to
____/________ (mm/yyyy). Total award is $_______ (U.S. Dollars) per year for _________ years.
Signature of Sponsor: _________________________________ Date (mm/dd/yyyy): ____/____/________
Official Title: _____________________________ Office or Division: ______________________________
Address: _____________________________________________________________________________
Address where tuition and fees will be billed, if applicable:
____________________________________________________________________________________
Please affix official seal of funding institution if available.
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To be used by students financially dependent on (Ohio State University, Columbus)

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Completed 5 August 2021

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