Fillable Printable Affidavit of Financial Support Form - Illinois

Affidavit of Financial Support Form - Illinois

Affidavit of Financial Support for

International Students

Complete both sides of this form and provide documentation as required. If you will need an F-1 or J-1 visa, the University of Illinois Springfield is required by U.S.

government regulations to check the availability of adequate funding for your tuition, fees, and living expenses for the duration of your studies. Until all funding documentation has been

completed and returned to the Office of Admissions, we will be unable to provide you with the documents necessary to obtain your visa. Proof of funds usually includes bank state-

ments or scholarship letters. Funds should be liquid. All documents should be current, in English; documents older than one year from the time of the student’s intended enrollment

cannot be accepted. These documents become the property of the Office of Admissions at UIS and will not be returned.

Last/family name First/given name Middle name

University Identification Number (UIN) Date of birth (month/day/year) Country of citizenship

Country of birth City of birth Country of residence

Are you presently residing in the United States? □ yes □ no If yes, what is your current status? □ F-1 □ J-1 □ other

If you hold an F-1 or J-1 visa, what institution issued the DS-2019 or I-20?

If you are presently an F-1 or J-1 student, where are you enrolled?

Applicant’s personal information

Estimated expenses for single student living

alone (without family) in the United States

The amounts below represent fees in effect fall 2014

through summer 2015, but they are subject to change

without notice. In 2015–2016 and beyond, students

should plan for a 5 to 10 percent annual increase for all

costs. In computing expenses, remember F-1 and J-1

visa holders will not be authorized to work except in

extraordinary circumstances. Therefore, you should

not expect part-time or summer employment to be a

significant means of support.

Costs listed are for an academic year

(two semesters/nine months).

Undergraduate

Health insurance is required for international

students.

Graduate

Health insurance is required for international students.

Tuition figured at Computer Science differential rate.

Additional estimated expenses for family

member(s) accompanying student to the

United States

Living expenses (nine months)

For spouse only $6,000

For each child $4,000

Tuition (12 hrs/semester) $14,844

Fees and Assessments $ 1,852

Books and supplies $ 1,200

Incidentals $ 2,700

Food, Housing, Utilities $ 9,600

Health insurance $ 636

Total estimated expenses

$30,832

Tuition (9 hrs/semester)

$12,708

Fees and Assessments $ 2,681.10

Books and supplies $ 1,200

Incidentals $ 2,700

Food, Housing, Utilities $ 7,750

Health insurance $ 636

Total estimated expenses

$27,675.10

We require these pieces of documentation:

1. Affidavit of support

A separate affidavit is required for each sponsor. The total funds on the affidavit(s) must equal the total funds

needed for one year of study at the University of Illinois Springfield. Letters of sponsorship must be for the

University of Illinois Springfield, and for no other college or university.

2. Bank statement

A bank statement must be supplied showing sufficient funds for the first year of study only.

The affidavit(s) of support and bank statement(s) that you submit must:

• be originals

• include both your name and the sponsor’s name

• be dated no more than one year prior to the date classes begin for the desired quarter

• be written in English; translations must be signed and sealed by the appropriate bank or government official.

The sponsor(s) on the Affidavit of Financial Support and the account holder(s) on the official bank

statement(s) must be the same.

Directions: Ask your personal sponsor(s) to complete the appropriate sections below. A separate signature

is required for each sponsor.

Personal sponsor: Date:____________________________

Last/family name:______________________________________ First/given name________________________________

Relationship to applicant:______________________________________________________________________________

Address:___________________________________________________________________________________________

__________________________________________________________________________________________________

Signature: _________________________________________________________________________________________

□ I will provide Full financial support for the applicant’s educational and living expenses for the entire length

of study at the University of Illinois Springfield. As verification that funding is available, I have attached an

original bank statement for the first year of study.

□ I will provide partial financial support.

If providing partial support, please indicate amount per year: $_______________

Duration of support: □ one year □ two years □ three years □ four years □ other_______________

□ I will provide full support for spouse and/or children if accompanying applicant to the United States.

Required documents

Affidavit of support from personal sources (family, friends, self)

Acceptable evidence of financial support: Unacceptable financial documents:

 Bank statements indicating required currency amount  Chartered account statements

 Investment statements including liquid assets  Payroll reports/expected income

 Scholarship letters  Tax statements

 Line of credit  Property Assessments

 Governmental funding  Credit cards

 Bank statements lacking currency amounts

 Other statements of non-liquid assets

Personal sponsor: Date:__________________________________

Last/family name:___________________________________________________________ First/given name___________________________________________________________

Relationship to applicant:_____________________________________________________

Address:___________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

Signature: _________________________________________________________________________________________________________________________________________

□ I will provide Full financial support for the applicant’s educational and living expenses for the entire length of study at the University of Illinois Springfield. As

verification that funding is available, I have attached an original bank statement for the first year of study.

□ I will provide partial financial support.

If providing partial support, please indicate amount per year: $_______________

Duration of support:

□ one year □ two years □ three years □ four years □ other_______________

□ I will provide full support for spouse and/or children if accompanying applicant to the United States.

Directions: Please ask your funding agency to either complete this form or provide an original letter including the following details regarding your support:

The affidavit of support that you submit must:

• be original

• include both your name and the sponsor’s name

• be dated no more than one year prior to the date classes begin for the desired quarter

• be written in English; translations must be signed and sealed by the appropriate bank or government official.

We,

____________________________________________(name of sponsor),

hereby certify that we will pay the following expenses for

_____________________________________________(applicant)

from

__________________________________________ (country).

□ tuition and fees □ living expenses for student

□ health insurance □ living expenses for spouse and children

Study is approved for

______________________________________ (degree)

________________________________________ (field of study)

at the University of Illinois Springfield.

Funding is effective from

_____ / ______ (mo/yr) to _____ / _____ (mo/yr).

Total award is $

______________(U.S. dollars) per year for ________ years.

I, ________________________________________ (applicant’s printed name), hereby promise that the information provided is correct and com-

plete. I understand that I ultimately am responsible for all anticipated yearly expenses for the length of my stay in the United States.

Applicant’s Signature__________________________________________________________________________ Date:____________________

You are advised to keep copies of all financial documents submitted to the University of Illinois Springfield. Similar information will be required by the United States Consular Office

Affidavit of support from personal sources (family, friends, self) continued

Affidavit of support from the funding agency (government, organization, or institution/school)

Official seal of funding institution

(if available)

Applicant’s declaration (signature is required)

Mail this completed form and accompanying information to:

Office of Admissions

University of Illinois Springfield

One University Plaza, MS UHB 1080

Springfield, IL 62703-5407, USA

Other Contact Information:

Phone: (217) 206-4847—Toll-free 1-888-977-4847

Email: [email protected]

Signature:__________________________________________________________

Date:_____________________________________________________________

Official title:________________________________________________________

Office of division:____________________________________________________

Address:___________________________________________________________

__________________________________________________________________

Address where tuition and fees will be billed, if applicable:

__________________________________________________________________