Fillable Undergraduate International Applicant Supplement & Financial Verification Form (University of Denver)

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Undergraduate International Applicant Supplement & Financial Verification Form (University of Denver)

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Office of International Student Admission
2197 S University Blvd, Denver, CO 80208
Phone: 303-871-2790 | Email: intladm@du.edu
Undergraduate International Applicant Supplement & Financial Verification Form
LAST (FAMILY) NAME:
Enter your information exactly as it appears on your passport.
LAST (FAMILY) NAME:
FIFIRRSST NT NAAMMEE::
SECTION 1B: Biographical Information (REQUIRED)
CITY OF BIRTH: COUNTRY OF BIRTH:
COUNTRY OF CITIZENSHIP:
COUNTRY OF LEGAL RESIDENCE: DATE PASSPORT EXPIRES:
SECTION 1A: Current Immigration Status (REQUIRED)
Are you currently in the United States as a refugee, asylee, or DACA recipient? Yes No
If yes, you do not need to complete the rest of this form.
Are you currently in the United States with a non-immigrant visa status? Yes No
If yes, what is your current immigration status?
Will you study at DU in a non-immigrant student visa status (F-1 or J-1)? Yes No
If no, you do not need to complete the rest of this form. If yes, which visa status do you intend to hold? F-1 J-1
Note: J-1 status is for students with significant funding from an organization such as a government, embassy, or university. If you
are interested in J-1 status but are not sure if you qualify, please contact International Student & Scholar Services at isss@du.edu.
Student visa status requires that you have a permanent address in your home country. This address cannot be a P.O. box.
SECTION 1C: Address in Home Country (REQUIRED)
CITY:
STATE/PROVINCE/REGION:
COUNTRY: POSTAL CODE:
STREET ADDRESS 1:
STREET ADDRESS 2:
LALASST (T (FFAAMMILILY) NY) NAAMMEE::
If you will bring a spouse in dependent (F-2 or J-2) status, complete their information exactly as it appears on their passport.
FIFIRRSS NT T NAAMMEE::
SECTION 1D: Dependent Spouse Information (REQUIRED IF A SPOUSE WILL JOIN YOU IN THE U.S.)
MIDDLE NAME::
LALASST (T (FFAAMMILILY) NY) NAAMMEE::
If you will bring a child under 21 in dependent status, complete their information exactly as it appears on their passport.
FIFIRRSS NT T NAAMMEE::
SECTION 1E: Dependent Child (Under 21) Information (REQUIRED IF A CHILD WILL JOIN YOU IN THE U.S.)
MIDDLE NAME::
Note: You may use extra pages to provide information for additional dependent children under 21.
MONTH OF BIRTH:
DAY OF BIRTH: YEAR OF BIRTH: CITY OF BIRTH: COUNTRY OF BIRTH:
COUNTRY OF CITIZENSHIP:
COUNTRY OF LEGAL RESIDENCE: GENDER (male/female/other):
MONTH OF BIRTH:
DAY OF BIRTH: YEAR OF BIRTH: CITY OF BIRTH: COUNTRY OF BIRTH:
COUNTRY OF CITIZENSHIP:
COUNTRY OF LEGAL RESIDENCE: GENDER (male/female/other):
MIDDLE NAME (INCLUDE ANY INITIALS):
International Student & Scholar Services
2200 S Josephine St., Denver, CO 80208
Phone: 303-871-4912 | Email: isss@du.edu
SECTION 1: Admitted Student Information
Pg 1 of 3
SECTION 2: Financial Verification
DU ID: LAST (FAMILY) NAME: FIRST NAME:
Please verify that you understand and accept the following items by initialing each item.
____ I will only provide documentation of funding that I will actually have access to during my course of study.
STUDENT SIGNATURE: DATE:
SECTION 2B: Complete if you have PERSONAL FUNDS
Funds Available (USD): $
I certify the above named student will have access to the funding listed here during their first year at DU.
SPONSOR NAME:
SPONSOR EMAIL:
SPONSOR SIGNATURE: DATE:
____ If I choose to stay in the United States during summer quarter, I am responsible for cost of living, tuition, and
fees for that quarter. Those costs are not outlined in the Cost of Attendance for my program.
The Cost of Attendance for my program:
____ assumes a moderate budget and does not include moving costs such as travel or housing deposits
____ is not a tuition bill and all costs are subject to change
____ does not include additional costs for dependents
____ The University of Denver has limited on-campus employment options and can only guarantee the scholarships
and assistantships that have already been offered to me.
STUDENT SIGNATURE: DATE:
SECTION 2C: Complete if you have FAMILY or PRIVATE SPONSOR FUNDS
If you are submitting financial documents belonging to an individual other than yourself, that individual must complete
this section. Do not sign on behalf of your private sponsor. You may submit multiple different bank documents.
Funds Available (USD): $
SPONSORING AGENCY:
ADVISOR/CONTACT EMAIL:
ADVISOR/CONTACT PHONE:
If you have a scholarship from an organization other than DU (such as your government or employer), complete this
section. You must submit a scholarship award letter or a financial guarantee from your sponsoring organization.
Annual Scholarship Award (USD): $
DU ID: LAST (FAMILY) NAME: FIRST NAME:
You must provide proof of available funding to cover estimated academic and living expenses for one
academic year (3 quarters/2 semesters).
• You may use any combination of the documents outlined on this form to show the required funding.
• You may submit multiple different bank documents belonging to the same person.
• Scholarships from DU count toward the required funding.
• Letters must include a signature from an official at the issuing organization.
• All documents must:
o be in English, or accompanied by a certified English translation
o be dated within the past 6 months
o include the name, seal, and address of the organization
If you are submitting your own bank documents, complete this section. You may submit multiple different bank documents.
SECTION 2D: Complete if you have A NON-DU SCHOLARSHIP or SPONSORING AGENCY FUNDS
ADVISOR/CONTACT AT SPONSORING AGENCY:
What are the requirements for you to maintain your sponsorship (GPA, course load, etc.)?
SECTION 2A: Student Information and Attestation (REQUIRED)
Pg 2 of 3
1) What is the current exchange rate of your country's currency to USD?
2) Do you plan to use similar funding for each year of your program of study?
a) If yes, have you verified that any scholarships will be available every year?
b) If no, what will your alternate sources of funds be?
3) Will you have access to emergency funds while you are in the United States?
a) If yes, what is the source of funds?
4) Do you know how you will pay for travel to and from the United States?
a) If yes, how?
b) If no, what is your deadline for organizing travel funds?
=$1
This optional section is to help you plan and will not impact your eligibility for a Form I-20 or Form DS-2019.
SECTION 2G: FINANCIAL PLANNING (OPTIONAL)
Yes No
You can find information on financial wellness and financial planning at https://www.du.edu/admission-aid/financial-aid-
scholarships/financial-wellness.
Yes No
2) Does your government currently impose restrictions on exchange and release of funds for study in the
United States? Yes No
a) If yes, describe the restrictions.
Yes No
SECTION 2E: Complete if you have a DU SCHOLARSHIP or ASSISTANTSHIP FUNDS
If you have been awarded a scholarship or assistantship by the University of Denver, complete this section. You only need
to provide documentation of your award if it is not on your admission letter.
Annual Scholarship/Assistantship Award (USD): $
What are the requirements for you to maintain your scholarship (GPA, course load, etc.)?
Yes No
If yes, how will it change?
Will your scholarship/assistantship funding change during your course of study?
SECTION 2F: HEALTH INSURANCE (REQUIRED)
All international students and their dependents are required to have health insurance for the duration of study. This cost is
included in your Cost of Attendance. DU's Health and Counseling Center offers a Student Health Insurance Plan (SHIP).
You can find more information about SHIP at https://www.du.edu/health-and-counseling-center/coveragecosts/ship.html.
If no, what organization will you get your health insurance from?
Note: The Health and Counseling Center will help you enroll in SHIP. You can contact them at info@hcc.du.edu.
Do you plan to enroll in SHIP?
Yes No
Pg 3 of 3
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Undergraduate International Applicant Supplement & Financial Verification Form (University of Denver)

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Completed 29 August 2020

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