Office of International Student Services

8700 NW River Park Drive Box 3 Parkville, MO 64152-3795 Tel. (816) 584-6834, 6379 Fax (816) 505-5443 international@mail.park.edu

AFFIDAVIT OF SUPPORT FORM

Affidavit of support for _________________________________________________ (Full Name of Applicant)
This document must contain all of the appropriate signatures and notarizations before a prospective student application is considered for admission to Park University. Supporting bank statements and/or other financial documents must be submitted with this document. The affidavit and supporting bank statements must be dated within 6 months of submitting your application for admission.

Statement from Family or Sponsor I, _________________________________, commit to providing financial support to the above named individual for their duration of studies, whose relationship to me is _________________. The exact nature and amount of my support is as follows: Tuition: ___Yes ___No Room/Food: ___Yes ___No Books: ___Yes ___No

Health Insurance: ___Yes ___No

Personal Expenses: ___Yes ___No

Total Amount per 12-month Period: __________________ I understand that the University will not be able to assist the prospective student financially (unless specified otherwise), and I, the undersigned, understand that I am fully responsible and accountable to the University, for maintaining the terms and statements of this form. (sign only in presence of Notary) __________________________________ Family/Sponsor Signature __________ ____________________________ Date Email address/telephone

____________________________________________________________________________ Family/Sponsor Address

___________________________________ Seal and signature of Notary Public or Government Official or Administer of Oaths