THEUNIVERSITYOFTEXASATDALLAS FinancialAffidavitforF1Students

InternationalStudentServices 800W.CampbellRoad,SSB34/Richardson,TX750803021 phone9728834189

TheU.S.DepartmentofHomelandSecurityrequiresthatallF1studentsshowproofoffinancialsupportforeachyearof universitystudyintheUnitedStates.UTDallasisrequiredtohavefinancialsupportdocumentationforoneacademicyear priortoI20issuance.

TousethisformandrequestaUTDallasI20,youmustbecurrentlyadmittedtoaUTDallasdegreeseekingprogram.Ifyou haveinquiriesrelatedtoadmission,applicationdeadlinesandfees,transcripts,TOEFLscoresandstandardizedtests,orother academicrequirements,visittheUTDallasOfficeofAdmissionsandEnrollmentServicesathttp://www.utdallas.edu/enroll/ orsendanemailtointerest@utdallas.edu.

STUDENT INFORMATION: ALL THE FIELDS IN THIS SECTION MUST BE COMPLETED.

Studentname(PRINT):

Dateofbirth:

Indicatethecasethatappliestoyou: IamcurrentlyoutsideoftheU.S.,andhavenotbeenintheUnitedStates(U.S.)withinthelast5months. IamcurrentlyoutsideoftheU.S.,buthavebeenintheU.Swithinthelast5months.Myvisatypewas:. IamcurrentlyinsidetheU.S.Myvisatypeis:** **F1statusstudentslivingintheU.S.andtransferringaSEVISrecordtoUTDallasmustfollowtheU.S.Departmentof HomelandSecuritytransferprocedures,outlinedintheUTDallasTransferStudentGuide:www.utdallas.edu/isso/trguide.

IfyourspouseorchildrenwillrequestanF2visatocometotheU.S.underyoursponsorship,fillouttheirinformationbelow. Relationship CountryofBirth FamilyName GivenName DateofBirth wifeorhusband sonordaughter sonordaughter sonordaughter

FINANCIAL INFORMATION: DETERMINE YOUR ESTIMATED EXPENSES.

Belowisalistoftheestimatedannualcostsofattendance,livingexpenses(basedonsharedhousinganduseofpublic transportation),andhealthinsurance.YoumustprovidefinancialcertificationoftheseminimumamountsasapartoftheI20 requestprocess(seethefinancialcertificationpageofthisform).Theseestimatesaresubjecttochangewithoutpriornoticethe exactcostswillvarybystudentandwillbedeterminedatthepointofcourseregistration. ADD $5000 PER SPOUSE AND $3000 PER
CHILD LISTED ABOVE.

Undergraduatestudents Tuition,12credithourspersemester LivingExpenses HealthInsurance Total Graduatestudents Tuition,9credithourspersemester LivingExpenses HealthInsurance Total

General $25,296 $13,700 $1,204 $40,200 General $2 , 96 $13,900 $1,204 $36,900

WithUTDallasScholarship $10,871 $13,700 $1,204 $25,775 WithUTDallasResearchorTeaching Assistantship,orScholarship $ $13,900 $1,204 $27,250

The University of Texas at Dallas /International Student Services / Financial Affidavit ISSO Copy / Reviewed 642012

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FINANCIAL CERTIFICATION: THIS FORM IS VALID FOR 6 MONTHS FROM THE DATE OF THE EARLIEST SIGNATURE.

Ifyouhavemorethanonesponsororaccount,attachanadditional,fullyfilledoutfinancialcertificationpageofthisform. Ifthebanksectionofthisformisnotcompleted,orifyouhaveanadditionalfundingsource,attachasupplementalfunding document.Examplesinclude:copyofbankstatement,scholarshipletter,UTDallasassistantshipletter,orgovernmentfunding supportletter.AllsupplementalfundingdocumentsmustmeettherequirementslistedontheUTDallaswebsiteat: http://www.utdallas.edu/isso/financials. MostUnitedStatesConsulatesorEmbassieswillrequireoriginalcopiesofallfinancialdocuments,includingbankstatements, whenyouapplyforanF1visa

STUDENTCERTIFICATION:ALL THE FIELDS IN THIS SECTION MUST BE COMPLETED.

Icertifythat:theamountoffundsindicatedinthebankcertificationsectiononthisformareavailableformyacademicstudyatThe UniversityofTexasatDallas;IhavesufficientfundingtosupporteachyearofmyeducationatUTDallas,includingfundsformy spouseandchildrenifapplicable;alloftheinformationprovidedonthisformiscorrectandcomplete;IwillnotifyTheUniversityof TexasatDallasofanychangeinmyfinancialcircumstances. Studentname(PRINT): Studentsignature:

Dateofbirth: Date:

SPONSORCERTIFICATION:IF THE BANK FUNDS ARE NOT IN THE STUDENTS NAME, THIS SECTION IS REQUIRED AND ALL THE
FIELDS IN THIS SECTION MUST BE COMPLETED.

IcertifythatIamwillingandabletofinanciallysupportthestudentnamedonthisformfortheamountindicatedinthebank certificationsectiononthisformforeveryyearofhisorherstudyatTheUniversityofTexasatDallas. Sponsorname(PRINT): Sponsorsignature:

Date:

BANKCERTIFICATION: ALL THE FIELDS IN THIS SECTION MUST BE COMPLETED.

Icertifythatthestudentorthesponsornamedonthisformhasfullaccesstothefundsdescribedinthissection.Further,Icertify thatthefundsdescribedinthissectioncanbewithdrawnatanytime,areliquid,andcanbeusedwithoutrestrictiontosponsorthe educationofthestudentnamedabovewhileintheUnitedStates. Thiscertificationisgivenforthestudentseducationalpurposein theUnitedStatesanddoesnotholdthebankresponsibleorliable. Officialbankstamporseal

Nameofbank: Addressofbank:

Nameofaccountholder: Lastfourdigitsontheaccount(s): Bankofficialsname(PRINT): Bankofficialssignature:

AmountavailableinUSDollars:

Date:

Title: Date:

FORM SUBMISSION INSTRUCTIONS:

1. 2.
ATTACH TO THIS FORMacopyofyourpassport.Alsoattachsupplementalfundingdocuments,ifapplicable. SUBMIT THIS FORM AND SUPPLEMENTAL DOCUMENTStotheUTDallasISSOinperson,bymail,orbyemail.

Inperson:SubmittotheUTDallasStudentServicesBuilding3.400. MondayThursday,8:30amto6pm.Friday,8:30amto5pm. Bymail(additionalelectroniccopiesarenotrequired):MailtoInternationalStudentServices/TheUniversityofTexasat Dallas/800W.CampbellRoad,SSB34/Richardson,TX750803021. Byemail(additionalpapercopiesarenotrequired): o Ifyouareanewlyadmittedstudent,emailyourdocumentstoISSOProspective@utdallas.edu. o Ifyouareacurrentlyenrolledstudent,emailyourdocumentstoISSOCurrent@utdallas.edu. o Verifythatthetotalsizeofattachmentsinoneemailisnolargerthan5MB.Donotsendfilesincompressed formats,suchas.raror.zip.Instead,useaPDF,JPEGorDOCformat.

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The University of Texas at Dallas /International Student Services / Financial Affidavit ISSO Copy / Reviewed 6-42012