CERTIFICATION OF FINANCIAL RESPONSIBILITY (CFR)

**This form is necessary for the preparation of a Form I-20/DS-2019 for The University of Texas at Austin**
(If you do not plan to enroll at the University in F-1 or J-1 status, you are not required to submit the CFR)

• This form is valid for ONE YEAR from date of signature. The appropriate immigration document will be issued
AFTER you have:
(1) been officially admitted to The University of Texas at Austin AND
(2) submitted this form along with proof of financial support for your studies
• Questions about the completion of this form may be directed to [email protected]
• Return the completed form to International Student & Scholar Services (ISSS) in one of the following ways:
(1) Email: [email protected] OR
(2) Fax: Domestic - (512) 471-8848; International - +001(512)471-8848 OR
(3) Mail: P.O. Box A, Austin, Texas 78713-8901 USA
• As you may need this documentation to prove to the United States consulate that you have sufficient funds, please keep your
original documents and submit photocopies to ISSS. Please note: ALL statements of support must be in English

STUDENT UTEID : ________________________________________

NAME AS LISTED IN YOUR PASSPORT: ___________________________________________________________________________________________

(family name) (given name) (middle name)

CITY & COUNTRY OF BIRTH:_______________________________________ COUNTRY OF CITIZENSHIP: ______________________________________

DATE OF BIRTH (MM/DD/YYYY): _________________________ MARITAL STATUS: Married _____ Single _____ Gender: Male _____ Female _____

ADDRESS WHERE IMMIGRATION DOCUMENTS SHOULD BE SENT:

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

Telephone: ________________________________________________________

MAIL DOCUMENT BY EXPRESS COURIER: NO ___ YES ___ If yes, you will be contacted by ISSS upon admission to UT Austin with further instructions.

THIS APPLICATION IS FOR: Semester _____________________ Year ___________________

Degree Level Sought: Bachelors ____ Master's ____ PhD ____ Major:_______________________________

TYPE OF VISA DESIRED: Student (F-1) ____ Exchange Visitor (J-1) ____ If J-1, indicate your occupation at home (e.g. teacher, graduate student.):

___________________________________________________________________________________________________________________________________

IF YOU ARE ALREADY IN THE U.S., indicate your current visa status: ___________

Will you be transferring to UT Austin from another US institution? ______________

LIST THE FOLLOWING INFORMATION FOR ALL DEPENDENTS YOU PLAN TO BRING WITH YOU (INCLUDING YOUR FUTURE SPOUSE, IF YOU
PLAN TO MARRY BEFORE TRAVELING TO THE UNIVERSITY). The statement of financial support must include sufficient support for any dependents that
will accompany you or plan to join you at a later date. Please note, a dependent is defined as a spouse or child.

Name (Last, First) Relationship Date of Birth (mm/dd/yyyy) City & Country of Birth Citizenship Gender

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

1
NAME: __________________________________________________ UT EID: ________________

You are required to certify that you will have sufficient funds available for your first year of expenses at The University of Texas at Austin. The cost,
based on 2009 estimates is: $44,500 for undergraduates, $30,300 for graduates, $54,000 for the Graduate School of Business and $50,500 for the
School of Law. For more information see: http://www.utexas.edu/international/isss/students/new. Estimates include tuition and fees for one academic
year and 12 months of living expenses. They do not include summer tuition. The cost of tuition is subject to change without notice. You should be
prepared to show the U.S. Consulate/Embassy how you will meet your program expenses. When computing your expenses, remember that students
should not look to employment as a means of support unless an offer of an academic appointment (teaching or research assistantship) accompanies
admission to a graduate department. Financial aid is generally not available to new international students, and financial assistance to continuing students
is extremely limited.

If you are a married applicant who plans to bring your spouse and/or child(ren), you must certify the availability of at least an additional $7,500 per year
for your spouse and $3,000 for each child. The spouse of an F-1 student visa holder is not permitted to work; the spouse of a J-1 exchange visitor visa
may apply for permission to work upon arrival in the U.S.

Students enrolled at the University are required to have health and accident insurance, which is included in the cost of tuition and fees. It is advisable
for all dependents to have health and accident insurance. Dependents of J-1 exchange visitors are required to have health and accident insurance which
could cost an additional $3,204 (spouse); $1,728 (children) per year.

SOURCES OF FINANCIAL SUPPORT AMOUNTS IN U.S. DOLLARS

First Year Second Year Third Year Fourth Year

Personal and/or family savings (a bank official's signature below or (required) (optional) (optional) (optional)
on an attached letter of certification is required if the applicant will be
supported in whole or part by personal family savings). Support is available
for a total of _______ years or time required to complete one degree. $ _________ $ __________ $ ________ $ ________
Government sponsor (print name of agency and attach signed copy of
letter from agency certifying sponsorship)

_________________________________________________________ $ _________ $ __________ $ ________ $ ________

University of Texas at Austin Assistantship/Fellowship/Scholarship

(attach copy of award letter from department) $ _________ $ __________ $ ________ $ ________

Other (Specify below and attach a signed certification)

__________________________________________________________ $ _________ $ __________ $ ________ $ ________

__________________________________________________________ $ _________ $ __________ $ ________ $ ________

BANK AND/OR SPONSOR'S OFFICIAL CERTIFICATION OF SOURCES OF FUNDS

This is to certify that I have read the information given by the applicant on this form, that it is true and accurate, and that the funds are
available and will be provided as specified:

Parent or Sponsor's Signature: ________________________________________________________Date: ______________________

Parent or Sponsor's Name (PRINT):________________________________________________________________________________
Relationship of Sponsor to Applicant: _____________________________________________________________________________
Address:______________________________________________________________________________________________________

This is to certify that I have read the information given by the applicant on this form, that it is true and accurate, and that the funds are available:

Bank Official's Signature: _____________________________________________________________________ Date:_____________

Bank Official's Name (PRINT): _________________________________________________________ Title: ____________________
Name and Address of Bank:______________________________________________________________________________________

I certify that the above information provided is correct and complete and that I shall not require additional financial assistance from The
University of Texas at Austin. If any of the information changes prior to my enrollment at the University, I will immediately notify ISSS.
I understand that making false or fraudulent statements within this Certification of Financial Responsibility may result in disciplinary ac-
tion.

Applicant's Signature: ____________________________________________________________________________ Date:______________