Declaration of Finances

In order to be eligible to attend Wartburg College, proof of financial support is required. To receive an I-20 form, the
Declaration of Finances must be accurately completed and submitted along with the required financial documents (bank
statements or documents showing proof of sponsorship). All bank statements must be current (within the last three months of
filling out this form). Please print.

Name: ____________________________________________________________ Date of Birth:

Last First Middle

Permanent Home Address: __________________________________________________________________________________

Number and Street

_______________________________________________________________________________________________________
City State Zip Country

ESTIMATED FINANCIAL SUPPORT FOR 2011-12 ACADEMIC YEAR

Tuition and Fees (2 semesters) $30,000

Room and Board $8,500
Other (Health Insurance, Personal Expenses, Books, and Supplies) $4,000
Total: $42,500

Amount in U.S. Dollars Available from Each of Your Financial Resources:

First-year students are required to have funds available each year for four years.
Transfer students are required to have funds available each year for at least two years.

Source of funds Annual funding available

Personal savings $
Parents and family funds $
Other (Other scholarships and sources) $
Government $

Students with Dependents

If a child or spouse accompanies you during your time at Wartburg College, additional proof of financial support for dependents’
living expenses and health insurance is required. Estimated annual living expenses and insurance costs (per dependent) are $5000.
Name(s) of Spouse or Children who will be living in the United States with you during your time at Wartburg College:
Name: ___________________________________________ Age: _________ Relationship: ____________________________
Name: ___________________________________________ Age: _________ Relationship: ____________________________

Sponsor Signature: 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. (If you have more than one sponsor, make a photocopy of this form for their completion.)
Name of Sponsor/Parent: _______________________________________ Relationship to Student: _______________________
Address of Sponsor: ______________________________________________________________________________________
Signature: __________________________________________________________________ Date: _______________________

Student Signature: I certify that the information provided above is accurate and complete.
Student’s Signature: __________________________________________________________ Date: _______________________