Declaration of Financial Support for F-1 Students

The Department of Homeland Security (DHS) requires that all F-1 students show proof of financial support for each year of university study in the United States. To meet this requirement, all F-1 students must submit:

1. A financial affidavit signed by the student and sponsor(s). 2. A bank statement or other comparable evidence of financial stability. This official document must be dated within six months of the start of the semester.

The current minimum amount required per academic year is $16,049 for a graduate student (add $5000 if you plan to sponsor your spouse and $3000 for each child you plan to sponsor). These amounts are subject to change without prior notice. This form should be used only by students who are sponsored by self, family members, or personal friends. Those who have official government or agency sponsors should submit their sponsor documents.

Please mail all official financial documents to the following address: Delta State University Graduate Admissions 1003 W. Sunflower Road, Kent Wyatt Hall, Room 239 Cleveland, MS 38733 UDENT PERSONAL INFORMATION STUDENT PERSONAL INFORMATION:

Name: First Middle Name Family Name Name

U.S. Addre ss (if applic able):

Perm anent Non- United States Addre ss (requir ed):

Home Email Phone Addre (Inclu ss: de Area Code) :

Field Degre of e Study: Sough t:

Expec Fall Spring Year: ted Date of Enroll ment:

Immi gratio n Infor matio n:

Yes No Are You Curre ntly in U.S.?

If Yes, Which Immigration F1 F2 J1 J2 Other (Specify Type): Status?

Admis sion (I-94) Numb er:

Town/ Count City ry of and Citize Count nship: ry of Birth:

Date Marita Single Married of l Birth Status (MM/ : DD/Y Y):

Pleas I plan to come alone to the U.S. e Check Appro priate Box: I plan to have my dependents come later to the U.S. I plan to bring dependents with me.

Pleas e Compl ete If Bringi ng Depe ndent s to the U.S.:

Family First Relati Date Country of Birth Name Name onship of Birth (MM/ DD/Y Y) Continued…

Declaration of Financial Support for F-1 Students, Page 2

Student Name:

FINANCIAL SUPPORT VERIFICATION: B. FINANCIAL SUPPORT VERIFICATION

Financial Sponsor(s): Total support from sponsors must be a minimum of $16,049.

Sponsor 1:

I have read the estimated budget for DSU graduate international students listed below, and I agree to support the student named above for a period of year(s) in the amount $ USD per year. of

Address:

Relationship to Student:

Sponsor 1 Signature: Date:

Sponsor 2 (If Applicable):

I have read the estimated budget for DSU graduate international students listed below, and I agree to support the student named above for a period of year(s) in the amount $ USD per year. of

Address:

Relationship to Student:

Sponsor 2 Signature: Date:

ESTIMATED GRADUATE FEES AND EXPENSES FOR 2013-2014 ACADEMIC YEAR

Tuition $ 6,012 Books and Supplies $ 1,000 Residence Halls (Average Double $ 4,510 Occupancy Meals $ 2,564 Required DSU International Student $ 888 Health Insurance Required Tuberculosis Chest X-Ray $ 75 Personal $ 1,000 TOTAL*: $ 16,049

*This is an estimate of minimal expenses only. Fees are subject to change at any time without prior notice. This budget does not include travel to and from the home country or vacation travel in the U.S.

DECLARATION

I have read the estimated budget for graduate international students listed above, and I understand that my admission to Delta State University is contingent upon my ability to pay all expenses during my attendance. I also understand that if I cannot meet my financial obligations, or if it becomes evident that I have acted in bad faith in making this declaration of financial support, I may be withdrawn from school. I further certify the information submitted on this declaration is complete and accurate, and that submission of inaccurate information can be considered sufficient cause for terminating my application or enrollment to Delta State University.

Student Signature: ______Date: ______