Fillable Printable Financial Statement of Responsibility and Financial Affidavit of Support - Michigan

Financial Statement of Responsibility and Financial Affidavit of Support - Michigan

FINR/FASP 8/2014

Eastern Michigan University

Financial Statement of Responsibility and Financial Affidavit of Support

(FINR/FASP)

This form is used for F-1 or F-3 student VISA applicants who are required to certify that they have sufficient funds to cover all

expenses while attending Eastern Michigan University. This form is NOT required for applicants who are a US citizen, permanent

resident or living within the US on another type of VISA for which they are eligible to study at the post-secondary/college/university

level. In those cases, submit a copy of your visa or other immigration documents to confirm your current immigration status.

FAXES, SCANS, OR PHOTOCOPIES OF THIS FORM AND ANY SUPPORTING FINANCIAL DOCUMENTS ARE NOT ACCEPTED.

I. APPLICANT

: (please enter name as shown on your passport and include a copy of your passport with this form)

_________________________________________________________________________________________________________

Last Name (Surname/Family Name) / First Name (Given) / Middle Initial / EMU Student number

Applicant’s Home Country Address (required for I-20): (Please print clearly)

Permanent Address Line 1:_____________________________________________________________________________________

Permanent Address Line 2: ________________________________City: ________________ Province/Region: __________________

Country: __________________ Postal/Mailing code: _________ E-mail: ____________________ Phone number: _______________

Current Immigration/Visa Status: Outside of U.S. F-1 J-1 H-4 H-1 Other (please specify): ______________

Gender: Male Female Marital Status: Single Married Date of Birth (mm/dd/yyyy):_________/_____/________

Birth Country: ________________________ Country of Citizenship: ________________________ Birth City: ___________________

Expected VISA Type: F-1 (I-20) F-3 (I-20) J-1 (DS2019—see OIS, 244 Student Center, [email protected] )

F-1: Full-time enrollment required F-3: Part-time Commuter visa type for Canadian passport holders only commuting within 75 miles of US border

Degree Sought: Bachelor Masters or Cert Doctorate Term: Fall (Sept. - Dec.) Winter (Jan. – Apr.) Summer (May- Aug.)

Indicate the program you intend to study (Required for I-20): __________________________________________________________

Will your spouse or children come with you? Yes No Enter the total number of dependents: ________________________

If Yes, include a copy of their passports and complete all information below: (use additional sheets if necessary)

Last Name First Name Relationship to

applicant

Date of Birth

(mm/dd/yyyy)

Country of Birth

Country of Citizenship Passport Copy

Included (X)

If you are an F/J VISA holder, what is your SEVIS (N) Number? N________________________SEVIS release date: ____/___/______ (mm/dd/yyyy)

If on F/J VISA, what US institution are you transferring from? __________________________________________________________________

Transfer students: submit the International Student Advisor Letter http://www.emich.edu/admissions/forms/international_student_advisor_letter.pdf

Select how you will receive your I-20(s):

a. _____ I will have my shipping paid for using Secure UPS CampusShip®. Go to WWW.UPS.COM to enter your shipping address and credit/

debit card payment information. Use this User ID and password to enter the EMU UPS CampusShip® account

User ID: EMU INTL Password: Newstudent1

In countries where UPS CampusShip® is unavailable, admitted students may contact our office to make arrangements for shipping via other couriers.

b. _____ I-20 “in-person” pick-up at 401 Pierce Hall_________________________________________________________________________

Name Email Phone

International Admissions

2 FINR/FASP 8/2014

II. SELECT YOUR ESTIMATED COSTS: The dollar figures in the plans below include costs projected for tuition and fees,

transportation, books, room and board, and mandatory health insurance. Costs are for one academic year for an international student at

EMU using current school year rates. Totals are shown in United States Dollars (USD) for minimum full time enrollment.

(Place an “X” next to your selection)

Plan 1

F-1 or J-1 VISA Applicants

(full-time enrollment)

Fall &

Winter

Plan 2

F-3 VISA Canadian Commuters

(part-time enrollment)

Fall &

Winter

Plan 3

12-month F1/J1 or students

starting in the Summer

Summer

Fall &

Winter

F1/J1 Graduate

31,354

F3 Graduate

16,555

Graduate

49,297

F1/J1 Undergraduate

36,031

F3 Undergraduate

18,893

Undergraduate

53,019

III. FINANCIAL AFFIDAVIT OF SUPPORT

FAXES, SCANS, OR PHOTOCOPIES OF THIS FORM AND ANY SUPPORTING FINANCIAL DOCUMENTS ARE NOT ACCEPTED

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------

International applicants must submit a financial affidavit of support with the bank’s seal and original/live signatures to provide proof

of liquid funds equal to or exceeding the “Total USD for I-20 Eligibility” above. Official bank statements may be used to support

Financial Affidavits of Support. Applicants are encouraged to prepare 2 copies of financial documents (1 copy for EMU and 1 copy

for VISA interview purposes

Only liquid account types are accepted: 1) Cash in savings/checking account 2) Certificates of

Deposits (CD’s) or 3) US based money market account with immediate withdraw into US Dollars

ENTER LIQUID FUNDS IN USD

Applicant’s Financial Support

FOR BANK OFFICIAL USE:

VERIFICATION OF LIQUID FUNDS

Amount of student’s personal funds: USD_________

Amount Verified in USD___________________

Amount of expected EMU funds: USD_________ Name of account holder in English and in Native Language

Amount of funds from other sources: USD_________ Bank official’s name Title

Specify other sources of funds: (Family, scholarship,

sponsor)

Bank official’s signature Date

Total Funding: USD________

Bank name Bank address Bank e-mail

AFFIDAVIT OF FINANCIAL SUPPORT FROM PARENT OR SPONSOR:

I will provide financial sponsorship for the applicant for one academic year in the

amount of ________________________________USD

Sponsor Name (print)

Sponsor Signature Date

The above costs reflect the average cost for 1 year of minimum enrollment and do not include costs for additional credit hours that are not mandatory

per year. Students are responsible for all costs for the entire length of study at EMU as tuition rates and living expenses may increase without notice.

___________________________________________________________________________________________________________

Applicant’s Surname /Last Name / First Name (printed) Applicant’s Signature Date: mm/dd/yyyy

Add USD figures =>

Plan $

Total Optional HI

Total Living

Total USD for I-20

Eligibility

BANK STAMP HERE

Additional expenses (use the box to the right to add your plan + additional expenses)

- Health Insurance (Optional) Spouse 5,750

- Health Insurance (Optional) Each Child 2,834

- Living Expenses for each additional family member 6,325

MAILING ADDRESS FOR ALL FINANCIAL

DOCUMENTS

International Admissions

Eastern Michigan University

401 Pierce Hall

Ypsilanti, MI 48197 USA

International Admissions contact information

Web address: http://www.emich.edu/international

E-mail: international.admi[email protected]

Phone: 734.487.0205