Visa type period of stay Name of school or employer
___/___/____ to ___/___/____
___/___/____ to ___/___/____
___/___/____ to ___/___/____
If your current visa status is not F-1, enter the last day you are authorized to stay in the U.S., as shown on your
Form I-94, Arrival/Departure Record: ______/______/____________
mm dd yyyy
Do you plan to change your visa type prior to enrollment? ________ New visa type sought ______________________________
Have you applied for lawful permanent resident status in the U.S.? ____________________________________________________
Check here if you are currently attending or have attended another SEVIS-approved school, or if you are engaging in or have
completed optional practical training (OPT). In order to maintain your current F-1 status, you must ask your current school
to “transfer out” (release) your SEVIS record to Whittier College within 60 days of the academic program or OPT end
date. The gap between the Whittier College program start date and the previous program or OPT cannot be 5 months or
more if you wish to remain in the US during that gap.
Date of anticipated transfer release ______/______/____________
mm dd yyyy
Expiration date of F-1 visa in passport ______/______/____________
mm dd yyyy
Address to which the Form I-20 should be mailed, if dierent from permanent address listed in application:
The following address is valid until ______/______/____________
mm dd yyyy
__________________________________________________________________________________________________________
street
__________________________________________________________________________________________________________
city state/province country zip or country code
__________________________________________________________________________________________________________
phone cell
Financial Explanation/Special Circumstance
Please attach separate paper if there are any unusual expenses, debt, or special circumstances regarding your nancial situation
that you wish to explain.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
(over)
Additional information required on reverse.
Y
our application will not be considered complete without this form. Email your completed form to
internationaladmissions@whittier.edu for faster processing.
Current Visa Information
If you have previously been or are currently in the U.S. list all visa statuses you have held, starting with the current or most recent.
STUDENT’S NAME ________________________________________________________
Last Name First Name
mm dd yyyy
mm dd yyyy
mm dd yyyy
mm dd yyyy
mm dd yyyy
mm dd yyyy
Whittier College International Financial Certification
This form is designed to standardize nancial information provided by applicants to Whittier College. By completing and returning this form to the College, an
applicant, if admitted, may obtain the College’s authorization and issuance of a Certicate of Eligibility (Form I-20). Attach supporting documents. Individual
sponsors, such as parents or relatives, are required to sign the form and substantiate their ability to support the student by attaching an original ocial bank
statement or letter (in English) specifying the exact amount currently on deposit, or employer’s letter (in English) specifying the sponsor’s annual salary. All
letters must be specically addressed to Whittier College and must be dated within three months of the date of the student’s application to the University. A bank
ocials signature and bank seal are required on the certication if the student is partially or totally supported by personal savings. United States consuls
scrutinize the statements of nancial resources given by non-immigrant visa applicants. It is important that you answer each of the questions and obtain the appropriate
signatures, otherwise this form will be considered incomplete and your application will not be reviewed for admission to the College. A completed Financial
Certication will help United States consuls make their decisions and expedite the visa issuance.
Your Name :
Mr.
Ms.
Miss
Mrs. Birthday:
____________________________________________________________________________________________ ____________________
Complete the section below. Enter the expected amount of annual support from the following
sources. Enter amounts in US dollars. Please PRINT all entries.
Assured Support
Projected Support
First Year Second Year Third Year Fourth Year
A Certicate of Eligibility (Form 1-20)
will not be authorized until this form is completed and returned to the institution to which you are applying.
Both the form and certicate must be shown to the U.S. Consul to obtain a visa. I certify that the information on this form is true, correct, and complete.
I understand that any misrepresentation may be cause for refusing or revoking admission.
Signature of Student ______________________________________________________________ Date ______________________________________________
Ocial Certication of Sources of Funds and Amounts
This is to certify that I have read the information furnished
by the applicant on this form, that it is a true and accurate
statement, and that the funds are available and will be
provided as indicated.
________________________________________________
S
IGNATURE OF BANK OFFICIAL
Title ____________________________________________
Name of Bank ____________________________________
Address of Bank __________________________________
Date ____________________________________________
Parent’s signature is required (see certication
statement above.)
________________________________________________
S
IGNATURE OF PARENT
Address ________________________________________
Date ____________________________________________
Sponsor’s signature is required (see certication
statement above.)
________________________________________________
S
IGNATURE OF SPONSOR
Address ________________________________________
Relationship of Sponsor
to Student ______________________________________
Date ____________________________________________
What is the present exchange rate of your country’s
currency to the US dollar (for example, 10 pesos = $1)?
____________________________________________ =$1
Does your government currently impose restrictions on
exchange and release of funds for student in the U.S.?
Yes
No If yes, describe restrictions.
________________________________________________
________________________________________________
How will you pay for your transportation to the U.S.?
________________________________________________
$ $ $ $
Student’s Source of Funds
Personal or Family Savings
______________________
N
AME OF BANK
A bank ocial’s signature is
required on the certication
if the student is partially or
totally supported by
personal savings.
Parents
Money available from
sources other than savings.
______________________
F
ATHER S NAME
______________________
MOTHER S NAME
Please describe the source:
______________________
Sponsors
Money available from
sources other than parents.
______________________
S
PONSOR S NAME
______________________
SPONSOR S NAME
Please describe the source:
______________________
Your Government/Other
______________________
N
AME OF AGENCY
Enclose with this form a
signed copy of your letter of
award.
Total
MM/DD/YYYY
STUDENT’S NAME ________________________________________________________
Last Name First Name
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