OFFICE OF INTERNATIONAL PROGRAMS EXCHANGE STUDENTS FINANCIAL CERTIFICATION

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1 PART I: PERSONAL INFORMATION Family/Last Name: First/Given Name: Middle/Other Name: Permanent address in home country: Street: City: Postal Code: Country: U.S. address: Street: City: State: Zip: Date of birth: Month: Day: Year: Country of Birth: Country of Citizenship: Gender: Male Female Married Unmarried Please complete the following information about your spouse and/or child (children) only if they will come with you to the U.S. Telephone: Fax: Have you been notified of admission to our school? Yes No (We cannot issue an I-20 until you have been accepted) PART II: IF YOU ARE IN THE UNITED STATES, NOW, COMPLETE THIS SECTION. IF, NOT, GO ON TO PART III. What is your immigration status? You can attend regardless of your Immigration status. F-1 What is your SEVIS ID Number? Circle one of the following that indicates what your I-20 is for: o (1) Transferring/changing U.S. schools; o (2) Changing educational level/program at Salve Regina University; o (3) Reinstatement to F-1 Status Another status. Which one? Before we issue your Form I-20, we want to advise you. Please make an appointment to see the international student advisor. Do you plan to travel outside the U.S. before school starts? Yes. Tell us how you would like to get your I-20 in Part III. No. If you are F-1, you will receive school transfer or other instructions. If you hold another status, we must meet with you before issuing your Form I- 20. PART III: IF YOU ARE NOT IN THE U.S. NOW, COMPLETE THIS SECTION. Did you recently attend school in the U.S. in F-1 student Status? No Yes If yes, what was the last date of your attendance If you attended a U.S. school last term and are just home on holiday between academic terms, you are considered a School Transfer and need to have your record transferred to us before your Form I-20 may be issued. Please contact your 1

2 international student advisor at your previous school immediately to authorize the release of your record to us. Mail: Your Form I-20 will be sent express airmail to the name and address you indicate in the address box. PRINT YOUR NAME AND ADDRESS IN ENGLISH, EXACTLY AS IT SHOULD APPEAR ON THE ENVELOPE. Name: Street: City: Postal Code: Country: Phone number: Cost of Attendance for one year (divide by 2 if coming for a semester) Level of education Tuition Fees Living costs Total Undergraduate Exchange Waived Technology $200 Room $7000 Student Activities $300 Board $4950 Health Insurance $1428 Transportation $800 Total fees $1928 Books $900 Pers. items $1000 Total $14650 $16578 Divide all costs by 2 if only coming for one semester The purchase of Salve Regina Health insurance is compulsory If choosing to live off-campus, you must still show proof of the above living costs. 2

3 Part IV: Financial Support Do not complete until you have you have carefully read all the instructions How many semesters will you be at Salve?: 1 semester 2 semesters What will your major be: Enter your annual total cost (see previous page)= What is the exchange rate of your country s currency to the U.S. dollar (example 10 pesos =$1) What amount =$1? How will you support yourself for every year of your program of study? Please indicate how much will be provided or available to you for the semester OR the year: (Amounts must be in U.S. Dollars) Source of my Support Required Documentation (please note that you will not receive an I-20 without this documentation being provided). Personal Funds. Funds from this school Proof of Income (any of the following): Employer s salary statement on letterhead stationery with most recent pay stub, or If self-employed, salary estimate from private accountant or bank, or Income tax returns or receipts with most recent pay stub, or Pay stubs for last six months, or Documentation of investments Bank Statement in your name only. A monthly statement of balances and deposits. If another person s name appears on your bank statement, that person must complete a separate affidavit or submit a notarized statement permitting those funds to be considered as financial support for the student Copy of Award letter Enter Amount in US$: Funds from a family Funds from a second family Funds from a third family Free Room and Board from a local sponsor with whom I will live. Proof of Income (see above) Bank statement (see above) Proof of Income Bank Statement Proof of Income Bank Statement Proof of Income (see above) Photocopy of your deed, lease, current rent receipts or current phone bill to prove that you are the person who owns or rents the property. TOTAL 3

4 PART V:Family/Relative/Sponsor/Government or Employer Signatures This is to certify that I (we), the undersigned, have agreed to provide the funds indicated above to the applicant for the purpose of fulltime study at Salve Regina University and that I am (we are) submitting bank statements indicating the availability of these funds. Name Signature: Date: Relationship to Applicant: Part VI Applicant s Signature Certificate of Eligibility (Form I-20) will not be issued until this form is completed and returned to Salve Regina University with appropriate supporting documents. Without the supporting documents, the application will not be processed. Both the form and certificate must be shown to the U.S. Consul or Embassy to obtain a visa. This is to certify that the information given on this form is complete and accurate to the best of my knowledge. Salve Regina University reserves the right to require additional financial documentation from applicants whose countries impose currency exchange restrictions or other obstacles to the transfer of currency. Applicants from such countries will be notified of specific requirements when they have submitted complete applications. Signature: Date: 4

5 Copy of passport page My personal documents: Bank/asset statement Proof of income Funds from this school Award Letter Copy of contract Application Checklist BEFORE YOU SEND THE APPLICATION TO SALVE REGINA UNIVERSITY, PLEASE MAKE SURE YOU HAVE: Cash Sponsor s (parent or other) documents: I understand that both types documents MUST be attached. Proof of Income Bank Statement Free room and board sponsor s document: I understand that both types of documents MUST be attached. Proof of Income Proof of residence (lease, deed, rent receipts, copy of utility bill) Please return the application via to [email protected] or by fax to or by mail to the address below. 5