Fillable Printable Affidavit of Financial Support Form - California State University, Northridge

Affidavit of Financial Support Form - California State University, Northridge

Revised7/30/2015 PLEASECOMPLETEBOTHPAGES

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AdmissionsandRecords

InternationalAdmissions

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AFFIDAVITOFFIN A NCIALSUPPOR T

AllF‐1studentsarerequiredtoprovidedocumentationoffinancialsupportbeforeanI‐20documentcanbeissued.

Ifthestudentwillusehis/herownpersonalfundsasthesourceoffinancialsupport,thestudentMUSTPROVIDEABANKSTATEMENTshowingthe

availabilityofatleast$35,000(undergraduates)or

$34,000(graduates)inliquidassets.Bankstatementsandfinancialaffidavitsshouldbedated

noearlierthanJUNE1

forSpringapplicationsorOCTOBER1

forFallapplications.

Ifthestudentwillbesupportedbyaprivatesponsor(familymember,friend,orprivateinstitution),thesponsormustsigntheStatementof

FinancialObligationbelow.Inaddition,sponsorsMUSTPROVIDEABANKSTATEMENTshowingtheavailabilityofatleast$35,000

(undergraduates)or$34,000(graduates)inliquid

assets.

Ifthestudentwillbesponsoredbyapublicagency(embassy,homegovernment,publicinstitution,religiousorganization,etc.),theagencymust

providewrittenverificationthatthecostswillbecovered.Sponsorshipstatementsshouldreflectthesemesterandyearoftheapplication.

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EstimatedStudentExpensesForOneSchoolYear(2 semesters)

(Theseamountsareestimatesandaresubjecttochangewithoutnotice.Actualexpensesmayvary.)

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 Undergraduate Graduate

Expenses

24units/2semesters

18units/2semesters

Tuition‐‐at$372perunit$8928.00$6696.00

Fees  6564.00 7830.00

BooksandSupplies1826.00 1826.00

RoomandMeals  13050.00 13050.00

Insurance(12monthcove rage)1725.00 1725.00

Otherexpenses(includingtransportationandpersonalexpenses) 2907.00 2873.00

TOTAL

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$35,000.00  $34,000.00



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FamilyMembers.Studentswhowillbeaccompaniedbyaspouseand/orchildrenwillneedtosubmitadditional

documentationoffinancialsupport($5000forspouseand$3000foreachchild).

Note.MBAandMSAstudentspayanadditionalamountof$254.00perunit.

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StatementofFinancialObligation

StudentsrequiringaformI‐20mustcompletethisStatementofFinancialObligationandsupplyallappropriatedocumentationoffinancialsupport.

Ifthestudentwillbesupportedbyfundsotherthanhis/herperso nalfunds,thesponsormustsignbelow.Ifmorethanonesponsorwillprovide

financialsupport,eachsponsormustsignourFinancialAffidavitform,andeachsponsormustprovideanofficialbankstatementshowingthe

availabilityofthenecessaryfunds(pleaseseeEstimatedStudentExpensesabove).

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Sponsor’sname(Print)_____________________________________________________________Relationshiptostudent___________________

Sponsor’ssignature________________________________________________________________________Date_________________________

Student’sname(Print)_____________________________________________________________

Student’ssignature__________________________________________________________________________Date________________________



Bysigningabove,thestudentandsponsorcertifythatsufficientfinancialresourceswillbeavailabletocoverallexpensesforthedurationof

studiesatCSUNorthridge.Further,bysigningabove,thestudentagreestomaintainadequatehealthinsuranceforthedurationofstudies.

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Ifaspouseand/orchildrenwillbeincludedontheI‐20,pleaseprovidethefollowinginformation(Ifnecessary,useanextrasheetofpaper).



SpouseDateofBirth___________________________________

 (FamilyorSurname)  (GivenName)

CountryofBirthCountryofCitizenship   Gender:Female____Male______

ChildDateofBirth___________________________________

(FamilyorSurname)  (GivenName)

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CSUNAffidavitofFinancialSupportPage2of 2

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CSUNIDNumberorlast4digitsofUSSocialSecurityNumber(ifavailable)___________________________________

NameasitappearsonPassport______________________ ______________________________________________

 (FamilyNameorSurname)   (FirstNameorGivenName) 

DateofBirth(MonthDay,Year)__________ _______________Gender:Female________orMale________

CountryofBIRTH__________________________ CountryofCITIZENSHIP____________________________ 

IfyouarecurrentlyintheUnitedStates,whattypeofvisadoyouhold?(Forexample,F1,F2,B1,J1,A2,etc.)_______ 

  

PermanentaddressinyourHOMECOUNTRY:Pleaseprintclearly

StreetAddress



City

ProvinceorState_______________________PostalCode ______Country________________________________

Phonenu mberinHOMECOUNTRY

EmailAddress____________________

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1. AreyoutransferringtoCSUNfromaUSschool(incl udinglanguageschool,highschool,college,university)?

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__________YES__________NO

 IfyouansweredYES,pleaseprovidethefollowinginformation:

 NameofSchool

 CityandStateofSchool

 Monthand Yearyouended,orplantoend,yourenrollmentatthatschool

2. AreyouonOPT? YES  NO

 IfyouansweredYES,pleaseprovidethefollowinginformation:

 NameofSchoolthatauthorizedyourOPT

 Month,DayandYearyourOPTbeganandendingdate

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Pleasecompletebothpagesofthisformandmailoremailittotheaddressbelow.YourI‐20cannotbeissued untilwe

havereceivedthiscompletedformandallrequireddocumentationoffinancialsupport.Ifyouaretransferringfroma

schoolintheUS,thatschoolmustfirst

transferyourI‐20recordtousintheSEVISdatabase.

CaliforniaStateUniversity,Northridge

InternationalAdmissions,BayramianHall150

18111NordhoffStreet

Northridge,CA91330‐8207

[email protected]