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The purpose of the Certification of Finances is to help colleges and universities obtain complete and
accurate information about the funds available to international applicants who want to study in the
United States. Strict government regulations, rising education costs and economic conditions have
made verifying the financial resources of international applicants essential. Institutions do not have
the option of deciding whether to verify the financial resources of their international applicants;
financial verification must be made prior to institutional issuance of a Certificate of Eligibility (Form
I-20 or DS-2019).
Return this form directly to the college that provided or requested it. Do not send it to
the College Board.
The space below is for optional use by issuing institutions for listing student’s expected annual budget.
INTERNATIONAL STUDENT
Return directly to the college providing CERTIFICATION OF FINANCES 2011-12
or requesting this statement. CONFIDENTIAL
Mr. 4. DATE OF BIRTH 7. EXPECTED VISA TYPE
1. YOUR Ms. ■ F-1
NAME Mrs. __________________________________________________________________________ MONTH DAY YEAR ■ F-2
Miss FAMILY (surname) GIVEN (first) MIDDLE ■ J-1
(Circle one)
■ J-2
______________________________________________ 5. PLACE OF BIRTH (country)
■ G-1
2. PERMANENT
ADDRESS ■ G-2
______________________________________________ ■ G-3
■ G-4
3. MAILING
ADDRESS
______________________________________________ 6. COUNTRY OF CITIZ
ENSHIP ■ H
Other (specify) ________
(If different
from above) ______________________________________________
8. Enter the expected amount of annual support from the sources listed below. Enter amounts in U.S. 9. OFFICIAL CERTIFICATION OF SOURCES OF FUNDS AND AMOUNTS
dollars. Please PRINT all entries. Use an additional sheet of paper for explanations, if necessary.
This is to certify that I have read the information furnished by the applicant
ASSURED on this form, that it is a true and accurate statement, and that the funds are
SUPPORT PROJECTED SUPPORT available and will be provided as indicated.
STUDENT’S SOURCES OF FUNDS
2011-12 2012-13 2013-14 2014-15
SIGNATURE OF
BANK OFFICIAL____________________________________________________
8a. PERSONAL OR FAMILY SAVINGS
TITLE _____________________________________________________________
______________________________________
NAME OF BANK NAME OF BANK_ __________________________________________________
ADDRESS
A bank official’s signature is required on OF BANK _ ________________________________________________________
the certification if the student is partially
or totally supported by personal savings.
DATE _______________
8b. PARENTS Parent’s signature is required (see certification statement above).
Money available from sources SIGNATURE OF
other than savings. PARENT___________________________________________________________
______________________________________
ADDRESS _ _______________________________________________________
FATHER’S NAME
______________________________________ __________________________________________________________________
MOTHER’S NAME
Please describe the source: DATE _______________
______________________________________
8c. SPONSORS Sponsor’s signature is required (see certification statement above).
Money available from sources SIGNATURE OF
other than parents. SPONSOR _ _______________________________________________________
______________________________________ ADDRESS _ _______________________________________________________
SPONSOR’S NAME
______________________________________ __________________________________________________________________
SPONSOR’S NAME RELATIONSHIP OF
SPONSOR TO STUDENT_ ___________________________________________
Please describe the source:
DATE _______________
______________________________________
8d. YOUR GOVERNMENT 13. How will you pay for your transportation to the U.S.?_________________
_ ____________________________________________________________________