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2011 Declaration of Finances Form
2011 Declaration of Finances Form
Documentation for Student Visa Eligibility Please type or print. *Must be identical to name listed in passport
Please fax this form to the Application Processing Center Student name*: ___________________________________________
at: 607.254.5175. (Last/family) (First)
Address: _________________________________________________
Attach a copy of passport page and I-20 Address Verification Form. _________________________________________________________
_________________________________________________________
Email: ____________________________________________________
Date of birth: _______________
U.S. law requires that we have on file written documentation of financial support for all international students. We must receive this documenta-
tion before we can issue form I-20, which you need to apply for a student visa or to transfer from one school to another within the U.S. Providing
all of the information required on this form—including the signature of your parent or guardian, as well as the signature of an officer of your
bank or other financial institution—will meet that requirement.
Instructions (please read carefully and see reverse side for form to be completed):
1. The amount of support available must total the appropriate bud- that, to the best of his or her knowledge, the specified funds are
get for each year of study, as shown in the table on the other side available for your expenses at Cornell. Having that officer sign the
of this form (the relevant figures are in the last row of the table). appropriate space on the front of this form meets our require-
ment. Should the officer prefer, a separate letter may be attached.
2. Your parent or sponsor must sign in the space indicated, under
This letter must clearly specify the total costs per year (as shown
“Certification.” If you are receiving a government or private schol-
at the bottom of the table on the back of this form) and must
arship, a separate letter may be submitted. It must include the
indicate that, based on the officer’s experience, the stated funds
amount available for tuition, books and supplies, health insurance,
will be available.
and living and personal expenses, including semester and summer
breaks.
Note: A bank statement listing a current balance or deposits is not
3. From the bank, other financial institution handling your family’s sufficient. If needed, the letter may state that the letter has been
funds, or your parents’ employer, we must have an officer certify issued for educational purposes and implies no responsibility on
the part of the bank.
*Books and supplies for Architecture, Art, and Planning are $1,320; there is also a $700 facilities fee.
††
This is a one-time settling-in allowance.
Continued on back
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2011 Declaration of Finances
Documentation for Student Visa Eligibility Please type or print. *Must be identical to name listed in passport
Please fax this form to the Application Processing Center Student name*: __________________________________________
at: 607.254.5175. (Last/family) (First)
Address: _________________________________________________
Attach a copy of passport page and I-20 Address Verification Form. ________________________________________________________
________________________________________________________
Email: ___________________________________________________
Date of birth: _________________
Note: This financial information is required both to obtain an I-20 (Certificate of Eligibility for a Student Visa) and to apply for a student visa.
Sources of Funds
(see reverse side for base figures and guidelines for estimating expenses)
Please include the sources of support for all years of undergraduate study. The total must be equal to or greater than the total shown below.
Enter all amounts in U.S. dollars.
Assured Support, Projected Support
First Year Second Year Third Year Fourth Year Fifth Year
Your savings or your family’s savings*
Name of bank: __________________________
Your parents or sponsors, or both*
Name: _________________________________
Name: _________________________________
Your government†
Name of agency: ________________________
Cornell University†
Type of award: __________________________
Other‡
Specify: ________________________________
Certification
If we receive this form without these signatures, we will return it, which may delay the issuance of your visa.
My signature certifies that I have read the information furnished on this form and that I believe the parent or sponsor is able to provide the funds
indicated above.
Signature of bank official: ____________________________________________________ Date: __________________________________________
Name: ___________________________________________________________________ Title: ________________________________________
Bank: ____________________________________________________________________________________________________________________
name address
My signature certifies that I have read the information furnished on this form, that it is a true and complete statement, and that the funds will be
provided as indicated.
Signature of parent or sponsor: _______________________________________________ Date: __________________________________________
Name: ___________________________________________________ Relationship to applicant: __________________________________________
Address: _________________________________________________________________________________________________________________
My signature certifies that the information on this form is true and complete. Also, I agree to enroll in an approved sickness and
accident–insurance plan for the duration of my study at Cornell.
Signature of applicant: _______________________________________________________ Date: __________________________________________