Confidential Statement Form – Fill Out and Use This PDF

CONFIDENTIAL STATEMENT FOR FINANCING STUDIES & SPONSORSHIP SUPPORT CONFIRMATION

SECTION A APPLICANT INFORMATION

For non-U.S. citizens and non-permanent residents of the U.S.

Please complete this form and submit it with all supporting immigration and financial documents to Boston University. Please note that an original financial form is required (photocopies or facsimiles are not acceptable). A copy of your passport ID page along with this document is required.

Student name (Last, First):

BU ID number:

( A S I T A P P E A R S O N P A S S P O R T )

Foreign Address (required for production of Form I-20)

Date of Birth:

/

/

Number and Street

Month

Day

Year

City

Province or state

Country

Zip/postal code

SECTION B BOSTON UNIVERSITY ESTIMATE OF EXPENSES FOR UNDERGRADUATE STUDENTS 2012/2013

The costs below are for the 2012/2013 academic year. These are estimates and cover the fall and spring semesters only. In order to obtain a visa to study in the U.S., you will also be required to demonstrate to the U.S. Consular post that you have adequate financial support for the upcoming academic year. You may wish to retain a photocopy of this original document for your records.

This form is necessary to certify that you have a minimum of $63,126 for your	$42,400		Tuition—all full-time students
first year of study. A Certificate of Eligibility (Form I-20) for a Student Visa	594		University Fees
will not be issued unless this form is completed and the necessary certifica-	1,914		Medical Insurance
tions are obtained. You may, along with this form, send an original bank let-	13,190		Housing and Meals—this estimate is for a typical
ter addressed to Boston University indicating that your education and living			double room in a residence and a minimum meal plan.
expenses for the amount stated will be provided by your sponsor. Please	1,000		Books and Supplies
note: monthly bank statements or balance sheets alone are not sufficient.	4,028		Incidentals (includes transportation, personal
All University charges are due and payable in full for each semester at the			expenses and vacation allowance)
time of registration. Tuition and fees are subject to change without notice.	$63,126		TOTAL for nine-month school year

Note: Need-based financial aid is available only to U.S. Citizens and Permanent Residents of the United States.

SECTION C SOURCES OF SUPPORT FOR FINANCING STUDY AT BOSTON UNIVERSITY

Amount of funds (in U.S. Dollars)

Personal or family savings (print name of bank)

$

Parents and/or sponsors (print name of each person)

$

Government or private agency (print name of the government department or agency)

			$
Other (specify)			$
		TOTAL	$

I certify that I have read the information provided by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.

Parent’s or sponsor’s signature				Relationship to applicant
Date

I certify that the statements given by me in this form are complete and accurate. Furthermore, I agree to assume all financial responsibilities should my source(s) of funding, as specified above, be interrupted or stopped.

Student signature

Date

SECTION D OFFICIAL CERTIFICATION OF SOURCES OF FUNDING

I certify that I have read the information provided by the applicant on this form, that it is a true and accurate statement, and that the funds described above are available.*Place bank seal here or attach a bank statement.

Bank official’s signature

Name of bank

Address of bank

Date