Fillable Printable Financial Affidavit of Support - Virginia

Financial Affidavit of Support - Virginia

Immigration document requested (F-1) I-20_______ (J-1) DS-2019_______

If currently residing in the U.S., list your entry visa _____________________

I intend to change my visa status to F or J while in the U.S.? YES NO

I intend to change my visa status to F or J by returning home? YES NO

Sponsor 1

Family Self Employer Other _______________

B: Name_____________________________________

__________________________________________

Address______________________________________

__________________________________________

Indicate relationship to Student :_____________________

C: Bank Name, Branch & Address

__________________________________________

D: I fully understand and have followed the above stated requirements for

I-20/DS-2019 issuance, and maintain the financial solvency to support the

academic studies of the above student for the stated duration and amount. All

statements submitted are original and of my ownership. Should any infor-

mation prove false, Old Dominion University is under no funding obligation.

Sponsor’s Signature__________________________________

Date _______/______/______ (mm/dd/yyyy)

Office of International Admissions

2101 Dragas Hall, Norfolk, VA 23529 U.S.A. ~ www.odu.edu/intladm

Student Applicant UIN______________________

Surname___________________________________________

First___________________________________________

Middle___________________________________________

Date of Birth _______/______/______ (mm/dd/yyyy)

Financial Affidavit of Support

Required if seeking F or J visa status

Acceptable Documentation of Financial Ability: Bank statements must include a summary of account, passbook or transaction

activity. Financial documents are valid for one calendar year from the desired date of enrollment.. All sections of this affidavit must be

completed by each sponsor; all original financial documentation must be mailed directly to the Office of International Admissions.

 Family/Personal /Friend Funds—Original, dated, bank issued statement demonstrating an equivalent numerical balance in U.S. dollars of

on-demand or liquid funds equal to the total first-year estimated costs.

 Government or Employer Sponsorship—Original letter must be addressed to Old Dominion University, and include all terms and provisions,

specifying exact amount of support, duration of funds, program of study and inclusion of any dependent or additional allowances.

 Educational Loans–Original, official loan guarantee verifying the terms and amount of secured funding.

 ODU Assistantships—Award letter from the graduate department indicating total funds, any tuition reduction, duration and origin of the

financial assistance. It is the recipient’s responsibility to insure International Admissions receives timely notification.

 Health Insurance—Year round health insurance is required, and students are automatically enrolled in a University sponsored health

insurance policy for the entire duration of their studies. Estimated insurance rates are included in the first-year estimated costs.

 Dependents—Spouses and children in F-2/J-2 status require additional funding for living and or health insurance expenses. List all

dependent information on reverse side. A copy of their passport identification page or birth certificate copy is required.

Unacceptable Documentation of Financial Ability: Documents issued beyond one calendar year by the date of enrollment;

photocopies, faxes or scanned attachments; property, employment, or pension income; educational loan applications.

A: Check level of guaranteed financial support

____ F-1 Total First-Year Expenses (

Estimated costs listed on reverse side.)

____ J-1 Total Program Expenses

____ Additional Years of Study $______________

____ Other Amount or Housing $______________

Sponsor 2

Family Self Employer Other _______________

B: Name_____________________________________

__________________________________________

Address______________________________________

__________________________________________

Indicate relationship to Student :_____________________

C: Bank Name, Branch & Address

__________________________________________

D: I fully understand and have followed the above stated requirements for

I-20/DS-2019 issuance, and maintain the financial solvency to support the

academic studies of the above student for the stated duration and amount. All

statements submitted are original and of my ownership. Should any infor-

mation prove false, Old Dominion University is under no funding obligation.

Sponsor’s Signature__________________________________

Date _______/______/______ (mm/dd/yyyy)

A: Check level of guaranteed financial support

____ F-1 Total First-Year Expenses (

Estimated costs listed on reverse side.)

____ J-1 Total Program Expenses

____ Additional Years of Study $______________

____ Other Amount or Housing $______________

Additional Considerations (some or all may not be applicable)

J-1 Students

List country of Permanent Residency: __________________________________________________________________________

List your current position or occupation: ________________________________________________________________________

SEVIS Transfers

If you have attended another academic program in F-1 or J-1 status during the five (5) months preceding your desired start date at

Old Dominion University, list your SEVIS ID and institution: N___________________/_____________________________________

ODU must be aware of your SEVIS release date (via the Transfer-in Form) before the transfer process can proceed. Sufficient proof

of funding for first-year expenses must be demonstrated before campus check in and course registration.

F-1 OPT or J-1 Academic Training

If participating in an Optional/Curricular or Academic Practical Training program , list start/end dates: ___________/___________

Current Old Dominion University Students

If you have taken leave from your F-1 or J-1 program, on what date did you depart the United States? _______/_______/_______

Full-Time Enrollment at the on-campus English Language Center (ELC)

If requesting an early arrival to begin intensive English language studies, indicate (circle) the desired term:

Spring I (January) Spring II (March) Summer I (May) Summer II (July) Fall I (August) Fall II (October)

First Year Estimated Costs for 2015/16*

Undergraduate (15 credit hours each term)

Tuition $26,800

Fees $500

Housing $6,500

Personal/Books $4,500

Health Insurance $2,000

ESTIMATE $40,300

Graduate (9 credit hours each term)

Tuition $20,900

Fees $350

Housing $6,500

Personal/Books $4,500

Health Insurance $2,000

ESTIMATE $34,250

Dependent 1 Relationship______________________

Surname_________________________________________

First_________________________________________

Middle_________________________________________

Date of Birth_______/______/______ (mm/dd/yyyy)

Country /City of Birth_________________/________________

Country of Citizenship__________________________________

Country of Permanent Residence ___________________________

Dependent 2 Relationship______________________

Surname_________________________________________

First_________________________________________

Middle_________________________________________

Date of Birth_______/______/______ (mm/dd/yyyy)

Country /City of Birth_________________/________________

Country of Citizenship__________________________________

Country of Permanent Residence ___________________________

*Estimates are based on full-time enrollment for the nine-month academic year: 15 credit hours for

Undergraduate Bachelors or 9 credit hours for Graduate Masters or PhD. Mandatory health insurance

costs are estimated for 12 months. Summer expenses are not included. These conservative estimates

are based on the needs of an average full-time student without dependents. Living costs increase annu-

ally, and are subject to change without notice.

**Dependents in F-2 status are not required to purchase the University sanctioned heath insurance

plan, however, ODU strongly encourages health insurance coverage for your spouse and children while

residing in the United States. Dependents in J-2 status, per federal law, must maintain a health insur-

ance policy that meets the requirements outlined by the Department of State.

DEPENDENTS Living Health Insurance** Additional Estimate

Spouse $2,500 $2,000 $4,500

Child (C) $2,300 $2,000 $4,300

Spouse + 1 C $4,800 $4,000 $8,800

Spouse + 2 C $7,100 $6,000 $13,100

Spouse + 3 C $9,400 $6,000 $15,400

Spouse + 4 C $11,700 $6,000 $17,700

Dependent 3 Relationship______________________

Surname_________________________________________

First_________________________________________

Middle_________________________________________

Date of Birth_______/______/______ (mm/dd/yyyy)

Country /City of Birth_________________/________________

Country of Citizenship__________________________________

Country of Permanent Residence ___________________________

Dependent 4 Relationship______________________

Surname_________________________________________

First_________________________________________

Middle_________________________________________

Date of Birth_______/______/______ (mm/dd/yyyy)

Country /City of Birth_________________/________________

Country of Citizenship__________________________________

Country of Permanent Residence ___________________________