Declaration of Finances and Affidavit of Financial Support for ...

CONTINUING EDUCATIONDeclaration of Finances andAffidavit of Financial Supportfor International (F1) StudentsMail to: American Language ProgramCalifornia State University, East Bay25800 Carlos Bee Blvd.Hayward, CA 94542-3012International applicants must provide proof of support totaling at least $5,500 tuition and roomand board (or $2,500 tuition and free room and board) per quarter of attendance in the IntensiveEnglish or Visiting Students Program. Please complete this statement of finances completely.The information you provide will determine what will appear on your I-20.Section 1 : APPLICANT INFORMATION AND LIST OF DEPENDENTSName on application:Family Name First Name Middle NameName on passport (if different):Country of birth:Date of birth:Country of citizenship:If you are married and plan to have your dependents live in the U.S. while you are attending theAmerican Language Program, please list your dependents below:Additional assets required for each dependents: $1,000 for your spouse, and $500.00 foreach child.Name:Place of birth:Name:Place of birth:Name:Place of birth:Relationship to applicant:Date of birth: (mm/dd/yy)Relationship to applicant:Date of birth: (mm/dd/yy)Relationship to applicant:Date of birth: (mm/dd/yy)Section 2: SOURCES OF FUNDS: Please check all that apply and provide required documentationTOTAL FUNDS AVAILABLE QUARTERLY MUST BE $5,500 OR $2,500 PLUS FREEROOM AND BOARD.PERSONAL FUNDS: Funds must be in the student’s name, and an original letter(not a photocopy) in English from the student’s financial institution must be provided.The letter should include the student’s name, total amount of founds available,and must be dated no earlier than one year before the start of the quarter forwhich the student is applying. DO NOT SEND BANK STATEMENTS.SEE OTHER SIDE OF THIS FORM

SCHOLARSHIP, GOVERNMENT, OR OTHER AGENCY FUNDS:An original letter (not a photocopy) in English from the sponsoring agency mustbe provided. The letter should include the student’s name, total amount offunds available, and must be dated no earlier than one year before the start ofthe quarter for which the student is applying.FAMILY OR PRIVATE INDIVIDUAL AS SPONSORSponsor’s Name:Sponsor’s complete address:Relationship to Applicant:Sponsor’s guarantee: I/we guarantee without reservation to support annually the educationalcosts and living expenses including tuition and fees, room, meals, books, supplies, health insurance,medical and emergency expenses, travel and personal expenses of the student named on thereverse of this form while he/she is enrolled in the American Language Program at CaliforniaState University, East Bay. I also agree to furnish additional support for this student’s dependentstraveling to the U.S.A., if any, as listed on the reverse of this form. I further guarantee thatthe student will not become a public charge during his/her stay in the United States.I will provide free room and board for this student.Sponsor’s Signature:Date:BANK VERIFICATION OF FUNDS (REQUIRED):Signature of Bank Official:Name of Bank:Date:Bank Stamp/Seal:Address of Bank:Note: In lieu of a bank seal or endorsement, your sponsor’s bank may choose to send an originalletter (not a photocopy) in English, signed by a bank official, indicating the amount of the fundsavailable.Section 3: APPLICANT’S SIGNATURE:All the information given above is true and correct to the best of my knowledge.Applicant’s Signature:Date:INCOMPLETE FORMS WILL BE RETURNED AND WILL DELAY YOUR ADMISSION.THIS FINANCIAL AFFIDAVIT MUST BE SIGNED BY THE STUDENT.