UNIVERSITY OF WISCONSIN OSHKOSH DECLARATION OF FINANCIAL RESOURCES for Underqraduate (Bachelors Deqree) Applicants This is to be completed by both the student and his/her.parent or guarantor. All signatures must be original and bank statements must be officially stamped or sealed. All amounts must be calculated in American (USA) dollars. All portions of this Declaration of Financial Resources form must be completed before a decision can be made on Your application for admission. Return completed form to:RICK HILLMAN, Office of Admissions University of Wisconsin Oshkosh 800 Algoma Blvd., Dempsey 135 Oshkosh, WI 54901-8602 (USA) Estimated Expenses for 1996/97 School Year Tuition and Fees $8,000.00 Living Expenses (Room, Board and Personal Expenses)$4,600.00 Books, Supplies and Insurance $1.600.00 EXPENSES FOR NINE MONTHS:$14,200.00 * If student plans to attend summer school, please add $3,500 to total. ** These figures are not inclusive of travel to and from your home country. Student's Name: _____________________________________________________________________ Last (family) First Middle Home Address: _____________________________________________________________________ Number and Street City Country Mailing Address: _____________________________________________________________________ Number and Street City Country Date of Birth: ________________________________ Month Day Year Place of Birth: _______________________________ Desired Visa Status: ___ Student(F-1) ___ Exchange Visitor ___ Immigrant ___ Diplomat or Official ___ Other (specify) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ FSFORM . 96 GENERAL INFORMATION 1. Area of Study: ________________________________________________________________ 2. Expected Years of Study: _______________ Degree Objective:___________________________ 3. Expected Starting Date: ________________ ________ Month Day Year 4. Friends or Relatives Attending UW Oshkosh ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. Marital Status: ___ Single ___ Married List all dependents you plan to bring with you: Relationship Date of Birth Nationality _____________________________ ___________________________________________ _____________________________ ___________________________________________ _____________________________ ___________________________________________ How will you support them? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. Father's Name: ________________________________________________________ Annual Income(USA dollars):____________________ Employer:________________________________________________________ Occupation: ________________________________________________________ Father Deceased: ____________________ Mother's Name:________________________________________________________ Annual Income(USA dollars):____________________ Employer: _________________________________________________________ Occupation: ________________________________________________________ Mother Deceased: ____________________ Sponsor's Name:________________________________________________________ Occupation: ________________________________________________________ Annual Income(USA dollars):____________________ 7. Parents Marital Status: ____ Married ____ Divorced 8. List Brothers and Sisters with Ages of Each: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 9. Number of Brothers or Sisters in College: ____________________________ 10. Number of your total dependents: ____________________________ 11. Does your family receive income from assets held in your country or in another country? Yes ___ No ___ 12. Does your family own any automobiles? Yes ___ No ___ 13. List your family s average annual expenses (USA dollars): Food: $_______________ Clothing: $_______________ Housing: $_______________ Rent/Mortgage $_______________ Taxes: $_______________ Other:(Explain) $_______________ Total $_______________ Explain: _________________________________________________________ 14. Value of family assets (USA dollars): Land and Buildings $_______________ Savings $_______________ Investments $_______________ Debts $_______________ Other $_______________ 15. Does your government impose any restrictions on release of funds for study in the United States? Yes ___ No ___ If yes explain: ________________________________________________________________________ ________________________________________________________________________ 16. What is the present exchange rate of your country s currency to U.S. dollars? ____________________________= ____________________________ Your country's currency United States Dollar THE ACTUAL AMOUNT OF MONEY (U.S.) AVAILABLE EACH YEAR HAS TO BE COMPLETED FOR EACH YEAR YOU WILL BE IN THE UNITED STATES AT UW OSHKOSH. A DECISION WILL NOT BE MADE WITHOUT THESE AMOUNTS / FILLED IN. SOURCES OF FINANCIAL SUPPORT (U.S. DOLLARS) SIGNATURE OF PARENT OR SPONSOR IS REOUIRED BELOW Please print (except Assured Projected signatures) First Year Sources Third Year Fourth Year Second Year 1. Personal and/or family savings: (A bank official's signature below or on an attached $____________$____________ $____________ $____________ letter is required) 2. Parents and/or sponsors: (Bank official's signature required) Print name of each. _________________________ $____________$____________ $____________ $____________ _________________________ $____________$____________ $____________ $____________ 3. Government Sponsor (Print name of agency) _________________________ $____________$____________ $____________ $____________ 4. Other: (Specify below and enclose certification) _________________________ $____________$____________ $____________ $____________ ----------------------------------------------------------------------- BANK AND/OR PARENT'S OFFICIAL CERTIFICATION OF SOURCE OF FUNDS This is to certify that I have read the information given by the applicant on this form, that it is true and accurate, and that the funds are available and will be provided as specified. Parents signature: __________________________________________________ Address: ____________________________________________________________ Date: ____________ Sponsors signature: _________________________________________________ Address: ____________________________________________________________ Date: ____________ Relationship of sponsor to applicant: ___________________________________________________________ Bank official signature: ______________________________________________________________ Name and Address of Bank: ______________________________________________________________ Do you plan to remain in the US during the summer? __ Yes __ No Do you plan on attending summer school? __ Yes __ No What are the sources and amounts of support available to you during the summer? Sources: US DOLLARS ______________________________ __________________ Sources: US DOLLARS ______________________________ __________________ I certify that the information provided here is correct and complete. Student signature ___________________________________________________ Date ____________________________ ** Providing false information may jeopardize a student's visa status and furthermore may result in an institution revoking its initial decision to enroll the student.