CONFIDENTIAL STATEMENT ON FINANCES
FOR FOREIGN STUDENTS
DIRECTIONS TO THE APPLICANT
Read the following directions carefully before completing and
submitting this form. All foreign student applicants must document their
ability to meet all education and living expenses for the entire period
of their intended study before this University can issue a Certificate
of Visa Eligibility (Form 1-20 or IAP-66). Please review
information about anticipated costs of attending Bucknell University.
If you are not applying for Financial Aid, attach an original bank statement indicating U.S. dollar
amount of personal/parent savings or notarized affidavit indicating guaranteed
support from a relative, government or other sponsoring agency.
| 1. NAME |
MR.
MRS.
MISS |
FAMILY NAME |
GIVEN NAME |
2. HOME
ADDRESS |
NO. AND STREET |
TOWN OR CITY |
PROVINCE OR STATE |
COUNTRY |
3. INDICATE IN THE FOLLOWING
TABLE THE SOURCES AND AMOUNTS OF MONEY IN U.S. DOLLARS THAT YOU EXPECT
TO HAVE AVAILABLE EACH YEAR TO MEET NECESSARY EXPENSES.
|
|
YEARS OF STUDY IN THE UNITED STATES
|
|
|
FIRST
|
SECOND
|
THIRD
|
FOURTH
|
| SOURCE OF FUNDS: |
20___ - ___
|
20___ - ___
|
20___ - ___
|
20___ - ___
|
| PERSONAL SAVINGS |
$_________
|
$_________
|
$_________
|
$_________
|
| PARENTAL SUPPORT |
__________
|
__________
|
__________
|
__________
|
Other sources (Please specify):
___________________________
___________________________ |
__________
|
__________
|
__________
|
__________
|
|
TOTAL:
|
__________
|
__________
|
__________
|
__________
|
4. HOW MUCH MONEY DO YOU EXPECT TO HAVE WITH YOU WHEN
YOU ARRIVE AT BUCKNELL UNIVERSITY? _______________________
5. DO YOU HOPE TO SUPPLEMENT THESE FROM SOURCES IN THE
UNITED STATES AFTER YOUR ARRIVAL? ____ YES ____
NO
IF YOUR ANSWER IS YES, DESCRIBE THESE PLANS IN DETAIL,
INDICATING SOURCES AND AMOUNTS OF THESE SUPPLEMENTAL FUNDS.
6. LIST THE PERSONS FINANCIALLY DEPENDENT
UPON YOU:
NAME |
AGE |
RELATIONSHIP |
WILL THIS PERSON
COME TO THE UNITED
STATES WITH YOU? |
| |
|
|
|
| |
|
|
|
| |
|
|
|
7. DO YOU HAVE ADDITIONAL
FUNDS AVAILABLE TO YOU IN CASE OF AN EMERGENCY AFTER YOUR ARRIVAL IN THE
UNITED STATES:
YES ________________
NO________________ AMOUNT AVAILABLE IN U.S.
DOLLARS: ___________________
CERTIFICATION
(The Application for Admission Can Not Be Considered
Unless You Have Read, Signed and Dated This Statement.)
10. I HEREBY CERTIFY THAT I HAVE READ AND DO UNDERSTAND
THE INFORMATION ON EXPENSES IN THE BULLETIN INFORMATION FOR FOREIGN STUDENTS
AND THAT THE INFORMATION I HAVE GIVEN ON THIS FORM IS COMPLETE AND ACCURATE
TO THE BEST OF MY KNOWLEDGE.
Signature of Applicant _________________________________________________
Date ______________________________
CERTIFICATION BY SPONSOR OR PARENT PROVIDING FINANCIAL
SUPPORT
11. (FOR YOUR APPLICATION TO BE CONSIDERED THE FOLLOWING
CERTIFICATION MUST BE SIGNED BY THE PERSON PROVIDING ANY PART OF YOUR FUNDS
OR BY AN OFFICIAL OF THE AGENCY, ORGANIZATION, OR FIRM SPONSORING YOUR
STUDIES. IF THE SPONSOR WISHES TO SUPPLEMENT THIS STATEMENT OR STATE
ANY SPECIAL CONDITIONS OR LIMITATIONS, A LETTER OF EXPLANATION MAY BE ATTACHED.
IF MORE THAN ONE SPONSOR IS AIDING THE APPLICANT, THE FOLLOWING MUST BE
COPIED, AND SIGNED BY EACH SPONSOR, AND THE ADDITIONAL STATEMENT ATTACHED
TO THIS FORM.)
THIS IS TO CERTIFY THAT I HAVE READ THE INFORMATION GIVEN
ON THIS FORM AND THE STATEMENTS REGARDING FINANCES MADE ABOVE BY THIS APPLICANT
FOR ADMISSION TO BUCKNELL UNIVERSITY. I AM (OR MY AGENCY IS) PREPARED
TO PROVIDE FUNDS TO PAY THE EXPENSES FOR THE PERIOD OF TIME AND TO THE
EXTENT INDICATED ABOVE. I AM MAILING THIS FORM DIRECTLY TO BUCKNELL.
Signature of Sponsor or Parent ____________________________________________
Date _______________________________
Name (Please print)
_______________________________________________
Title or Position ______________________________
Address _________________________________________________________________________________________________
COMPLETED STATEMENT, WITH
SPONSOR CERTIFICATION
SHOULD BE MAILED PRIOR TO FEBRUARY 1 TO:
THE OFFICE OF ADMISSIONS
BUCKNELL UNIVERSITY
LEWISBURG, PENNSYLVANIA 17837 |