Fillable Printable International Student Financial Affidavit - University at Albany

International Student Financial Affidavit - University at Albany

UNIVERSITY AT ALBANY

INTERNATIONAL STUDENT FINANCIAL AFFIDAVIT

Please read the appropriate instructions prior to completing this form.

Part 1

1. Name of Applicant: Mr./Ms.

2. Permanent Address:

3. University ID number (if known): - - Date of Birth (mm/dd/yr) / /

4. Department and degree applying to:

5. Current U.S. visa you hold (if any): _______________________________

Part 2

Complete each relevant item below. Sign and date the form at (C).

Enter the amount of assured support available in U.S. dollars for each year of study.

Source of Funds Year 1 Year 2 Year 3 Year 4 Required Verification

Personal Savings

Name of Bank:

$ $ $ $ 1. Bank Statement

2. Complete (A) and (C)

below.

Relative/Sponsor

Names:

$ $ $ $ 1. Bank Statement

2. Complete (B) and (C)

below.

Scholarship/Grant

awarded by:

$ $ $ $ 1. Official award letter.

See instructions.

2. Complete (C) below.

TOTALS

$ $ $ $

VERIFICATION

A. This is to certify that the funds indicated above are on deposit or are being held in the name of the applicant named above

at the savings institution named below. Verification of amounts is without liability for the bank or its officials. Attach

separate statement of accounts with official signature/seal.

Name of Bank: Date:

Bank Officer Name and Title:

Bank Officer Signature:

B. This is to certify that the undersigned has agreed to provide the funds indicated above to the applicant for the purpose of

full-time study at the University at Albany and is submitting bank statements indicating the availability of these funds. It

is further understood that the University might not provide any financial assistance to the applicant and the funds must be

provided for the duration of the applicant's course of study. If the commitment is not met, the student may be subject to

dismissal.

Sponsor: Relationship to applicant:

Signature: Date:

C. This certifies that the information given on this form is accurate to the best of my knowledge. I am fully aware that false

or misleading statements may result in denial of admission or cancellation of registration. By signing below, I fully

understand that I might not receive financial assistance from the University at Albany during my first year of study and

that the University is under no obligation to provide funds to me for future terms or in the event of an emergency.

Applicant's Signature: Date:

UNIVERSITY AT ALBANY

INTERNATIONAL STUDENT FINANCIAL AFFIDAVIT

All international students must document their ability to meet all educational and living expenses for the entire

period of their intended study before this university can issue a Certificate of Visa Eligibility (form I-20 or IAP-

66). If you do not have a personal source of financial funding and are anticipating departmental support

from the University at Albany, please indicate "0" in the boxes, sign the form and submit it to our office. If

you have full or partial funding, please read the following instructions and complete and submit the signed

form along with requested documentation.

INSTRUCTIONS: Part 1: Answer questions 1-4.

Part 2: In the first column, indicate the source(s) of your funding. In the columns headed

Year 1, 2, 3, and 4 indicate the amount (in U.S. dollars) available for each year of

study. Each sponsor must verify these amounts by signing the form as indicated. Be

sure to include supplementary original documents as indicated. Photocopies are not

acceptable.

All documentation must be dated within three months of the date of receipt. You

have been provided with an estimate of annual education and living costs for

international students. You must document financial support equal to or greater than

this amount. This estimate is subject to change without notice and will usually

increase each year.

SOURCES OF FUNDS REQUIRED DOCUMENTATION

Personal/Family Signatures of sponsors on this form. Bank verification on both this form and in a

separate statement of account.

Scholarship or Grant Official scholarship le tter from the institution or agency awarding the scholarship.

The award letter must contain the name of the applicant, the amount of money

available for each year of study, the duration of the award (including beginning and

ending dates), the degree and major field of study for which the award is valid, and

the address of the sponsoring agency.

Dependents If you intend to bring dependent family mem bers (spouse, children) with you to the

United States, please complete the attached form and retu rn it with your financial

affidavit. Each dependent requires proof of $4,000 in additional funding to cover

their living expenses.

The University at Albany reserves the right to require additional financial documentation and/or prepayment from

applicants whose countries impose currency exchange restrictions or other obstacles to the transfer of currency.

Applicants from such countries will be notified of specific requirements when they have submitted complete

applications.

Dependents

Instructions to request an I-20 for dependents

If you plan to bring dependent family members with you to the United States, you must

document $4,000 per dependent to cover living expenses on your Financial Affidavit form.

In addition, please submit the following information for each dependent:

Family Name: ______________________

First Name: ______________________

Date of Birth: ______________________

Country of Birth: ____________________

Country of Citizenship: _______________

Gender: ______________________

Relationship to You: _________________

Family Name: ______________________

First Name: ______________________

Date of Birth: ______________________

Country of Birth: ____________________

Country of Citizenship: _______________

Gender: ______________________

Relationship to You: _________________

Family Name: ______________________

First Name: ______________________

Date of Birth: ______________________

Country of Birth: ____________________

Country of Citizenship: _______________

Gender: ______________________

Relationship to You: _________________

Family Name: ______________________

First Name: ______________________

Date of Birth: ______________________

Country of Birth: ____________________

Country of Citizenship: _______________

Gender: ______________________

Relationship to You: _________________

Family Name: ______________________

First Name: ______________________

Date of Birth: ______________________

Country of Birth: ____________________

Country of Citizenship: _______________

Gender: ______________________

Relationship to You: _________________

Family Name: ______________________

First Name: ______________________

Date of Birth: ______________________

Country of Birth: ____________________

Country of Citizenship: _______________

Gender: ______________________

Relationship to You: _________________