Declaration of Finances

GEORGIA COLLEGE & STATE UNIVERSITY
DECLARATION OF FINANCES

INSTRUCTIONS: Please print, complete and return this form to the International Services & Programs Office, Georgia College & State University, Campus Box 49, Milledgeville, GA 31061-0490. Complete the amount and sources of all support in the table below. Please PRINT all entries and enter amounts in U.S. Dollars. You must show official certification of support either with a bank official's signature or a bank statement indicating a sufficient amount. In addition, you must have a parent's or sponsor's signature unless support is from your own personal savings. Use an additional sheet of paper for explanations if necessary. A copy of this completed form will be returned to you together with your Certificate of Eligibility (1-20). You will then present the Declaration of Finances and Certificate of Eligibility (1-20) to the U.S. Consulate to request a student visa.

Name: Mr. Ms. ________________________________________________

SOURCES OF SUPPORT ASSURED SUPPORT PROJECTED SUPPORT

FIRST YEAR SECOND YEAR THIRD YEAR FOURTH YEAR

PERSONAL OR FAMILY SAVINGS
______________________________
NAME OF BANK

PARENTS AND/OR SPONSORS ______________________________
NAME(S) FOR RESOURCES OTHER THAN SAVINGS
PLEASE EXPLAIN SOURCE

YOUR GOVERNMENT ______________________________
NAME OF AGENCY (ATTACH A SIGNED
COPY OF YOUR LETTER OF AWARD)

OTHER (SPECIFY) ______________________________
(ATTACH A SIGNED AFFIDAVIT FROM
SOURCE)

TOTAL $ $ $ $

OFFICIAL CERTIFICATION OF SOURCES OF FUNDS AND AMOUNTS This is to certify that I have read the information furnished by the applicant on this form, that it is true and accurate, and that the funds are available.

Bank Official's Signature ___________________________________________________

Bank Official's Name (Printed) _________________________ Title _________________

Name of Bank __________________________________________________________

Address of Bank _________________________________________ Date ___________

This is to certify that I have read the information furnished by the applicant on this form, that it is true and accurate, and that the funds are available and will be provided as specified.

Sponsor's or Parent's Signature _____________________________________________

Sponsor's or Parent's Name (Printed) ________________________________________

Relationship of Sponsor to Applicant _________________________________________

Address ______________________________________________________________

Do you plan to remain in the United States during the summer? Yes No
Do you plan to attend summer school? Yes No
What are the sources and amounts of support available to you during the summer?
_________________________ U.S. $ ___________
_________________________ U.S. $ ___________

I CERTIFY THAT THE INFORMATION PROVIDED HERE IS CORRECT AND COMPLETE.
SIGNATURE OF STUDENT ______________________________________ DATE _________________

TO BE COMPLETED BY THE INSTITUTION THAT SENT THIS FORM.
SIGNATURE OF GC&SU OFFICIAL ________________________________ DATE _________________

SOURCES OF SUPPORT	ASSURED SUPPORT	PROJECTED SUPPORT
SOURCES OF SUPPORT	FIRST YEAR	SECOND YEAR	THIRD YEAR	FOURTH YEAR
PERSONAL OR FAMILY SAVINGS ______________________________ NAME OF BANK
PARENTS AND/OR SPONSORS ______________________________ NAME(S) FOR RESOURCES OTHER THAN SAVINGS PLEASE EXPLAIN SOURCE
YOUR GOVERNMENT ______________________________ NAME OF AGENCY (ATTACH A SIGNED COPY OF YOUR LETTER OF AWARD)
OTHER (SPECIFY) ______________________________ (ATTACH A SIGNED AFFIDAVIT FROM SOURCE)
TOTAL	$	$	$	$