affidavit of financial support for international students

AFFIDAVIT OF FINANCIAL SUPPORT FOR INTERNATIONAL STUDENTS
Important: You must return this from along with an official bank statement from your funding source. The Bank
statement must not be any older than 60 days from date sent and must have enough funds to cover your
designated expenses. We recommend you request 2 original copies of each statement in case one gets lost in the
mail. If you are providing more than one bank statement, you must have a letter from each sponsor.
Instruction: Before filling out this form, please refer to the enclosed Estimate of Expenses and make sure that your
funding equals the amount necessary to attend Washington University. For students who have to take 45 credits
you have to provide financial statements in the amount of $47,202 for your first academic year.
Please complete this form in full. This form must be completed before Washington University can issue your visa
eligibility document: I-20 or IAP-66. All sources of support must be shown in US dollars for a nine-month
academic year, plus the cost of living expenses.
APPLICANT’S PERSONAL INFORMATION (please print):
Name: Last (family) First (given) Middle
_____________________________________________________________________________________________
Permanent Address:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Current Address: (if different from permanent address)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Country of Citizenship:
Date of Birth (month/day/year):
Marital Status (circle one): Single Married Divorced Widowed
DEPENDENT INFORMATION
Check the appropriate item:
1. ____ I plan to come alone
2. ____ My dependents will join me later
3. ____ The following dependents will accompany me to the U.S. (see next page)
List the dependents for 2 & 3:

Dependent’s Name
Birthdate
m/d/y
Country of birth /
Country of citizenship
Relationship to
you
Date they will
join you (no. 3)
AFFIDAVIT OF SUPPORT:
Please indicate the amount of funds available to you for the 2012-2013 academic year from:
1. Personal/Family $____________
2. Grants/Scholarships $____________ From Whom__________________
(must provide letter of award)
$____________ From Whom__________________
$____________ From Whom__________________
3. Sponsor $____________ (to be filled out by the sponsor and bank statement must be provided)
Name: Last (family) First (given) Middle
_____________________________________________________________________________________________
Address:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Relationship to applicant:
_____________________________________________________________________________________________
Signature:
_____________________________________________________________________________________________
Date:
_____________________________________________________________________________________________
4. Other source: $_________ Identify _____________
(Please ask your funding agency to provide an original letter stating its support to you)
5. Room and Board Sponsor* (circle one) YES or NO If yes, subtract $12,150 from total cost.*
6. Add all funds $__________ Does this amount equal to necessary funds (circle one) YES or NO
Amount Must Equal $47,202
*If you have someone in the United States who will provide Room and Board for you at no charge, you can deduct $12,150
from your cost of living, making $6,900 the amount you must show. A letter of support and bank statement from your sponsor
must accompany this affidavit.