Fillable Printable Financial Statement of Responsibility and Financial Affidavit of Support - Michigan
Fillable Printable Financial Statement of Responsibility and Financial Affidavit of Support - Michigan
Financial Statement of Responsibility and Financial Affidavit of Support - Michigan
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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
1.
3.
4.
2.
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
