Graduate Financial Verification Form – Fill Out and Use This PDF

OFFICE OF GRADUATE ADMISSIONS

Castle Point on Hudson

Hoboken, NJ 07030

Phone: 800.496.4935

Graduate.Admissions@stevens.edu

http://www.stevens.edu/sit/graduate/

2013-2014 Academic Year

Graduate Financial Verification Form

PART I: TO BE COMPLETED BY A STUDENT

NOTE: If you plan to use your personal funds to cover all of your educational and living expenses at Stevens, you do NOT need to submit this form. The only document you have to submit is a copy of your recent, official bank statement. If at least a portion of your financial support comes from a sponsor (parents, relatives, friends, organizations), both you and your sponsor have to complete this form. If a bank statement is in the name of more than one person, each individual must complete this form. This form does NOT have to be notarized.

Name of the student(first and last)

Complete Foreign Address

Telephone

E-mail

Stevens ID Number

Current Immigration Status (F-1,

F-2, H-1B, H-4, etc., if in the

U.S.)

If currently in the U.S., local address

PART II: BREAK-DOWN OF EXPENSES FOR 2013-2014 ACADEMIC YEAR

Please identify the source of funds for each of the categories in the table below. For the detailed break-down of graduate tuition and fees please go to http://www.stevens.edu/ssc/tuition_fees.html or contact the Student Service Center at ssc@stevens.edu or at 201.216.5555.

	Category	Amount	Source (personal or sponsor)
1.Tuition and fees		$31,344
2. Living expenses		$12,675
3.	Books and supplies	$1,212
4.	Health insurance (estimated amount, subject to change)	$1,400
5.	TOTAL (for items 1-4)	$46,631
฀ OPTIONAL American Graduate Experience *		$3,000
6. TOTAL with the American Graduate Experience		$49,631

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*Stevens American Graduate Experience is an exclusive summer enrichment program for graduate students to immerse themselves in the English language prior to the start of classes in the fall semester. The program will begin on Friday, July 19th and will run through Friday, August 2nd. For more information please visit http://gradlife.stevens.edu/summer. If you would like to participate in this program, please check the box in the table above and submit proof of $49,631.

IMPORTANT: If you plan to bring a dependent spouse or child in the U.S., please submit proof of additional

$13,600 PER EACH DEPENDENT, as well as copies of their passports, a copy of your marriage certificate (for a spouse) and a copy of your child’s birth certificate (if applicable). If the required documents are not in

English, please submit official English translations along with copies of the original documents.

PART III: TO BE COMPLETED AND SIGNED BY THE SPONSOR

NOTE: Please return a copy of the completed form along with a copy of your sponsor’s recent, official bank statement (and your personal bank statement, if applicable) to the Office of Graduate Admissions via e-mail at Graduate.Admissions@stevens.edu . Do NOT send your financial documents by mail or FAX.

Sponsor’s name

Relationship to the student (parent, sister/brother, aunt/uncle, friend, organization, etc.)

Complete address and telephone

Annual amount the sponsor will provide until the student completes the program at Stevens Institute of Technology

Signature of the sponsor

Date

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