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FinancialAffidavit_2023_24

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13 views3 pages

FinancialAffidavit_2023_24

Uploaded by

corrycages
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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International Affairs

Middle Tennessee State University


1301 East Main Street, Campus Box 120
Murfreesboro, Tennessee 37132

Financial Statement Form

Name of Applicant______________________________________________________________
(LAST NAME OR FAMILY NAME) (FIRST NAME)

MTSU Identification number (if known): M_________________________________________

Estimated tuition and registration fees are $27,098 per academic year, assuming that a student takes
only 12/9 credit hours per semester. This does not include housing and a meal plan. As housing
and meal plan rates vary according to what you may chose, please refer to the MTSU website for
current plans and prices at: www.mtsu.edu/tuition

The cost of international student insurance premiums vary and can range from an estimated $679.85
per semester to $1,631.64 per calendar year. MTSU has partnered with Lewermark, a company
specializing in health insurance for international students. All MTSU international students not
sponsored by their home government will automatically be enrolled in the MTSU international
insurance plan.

In addition, the student should expect to spend approximately $1,000.00 per year for textbooks and
supplies. Added cost of insurance, housing, meals, travel, clothing, cosmetics and miscellaneous
expenses are estimated at $8,153 per year. The applicant, therefore, should have a total of at least
$36,500 for a full academic year.

The above estimated expenses are for two (2) full semesters of school. Though optional, summer
session can be attended at extra cost. These expenses also are based on University housing and meal
plan programs available to all students. Actual expenses may be higher or lower depending on each
student’s personal needs and preferences and are subject to change without notice.

***********ALL PRICES QUOTED ARE SUBJECT TO CHANGE WITHOUT NOTICE***********


It is the student’s responsibility to have his/her financial situation in order before entering the
University. You must pay for your tuition, room, meal plan, insurance and fees upon registration. The
University does not have provisions to accommodate students arriving with insufficient funds. Students
not complying are in jeopardy of invalidating their immigration status and can be subject to
deportation.
To maintain legal non-immigrant status, undergraduate students must enroll for a minimum of 12/9
credit hours per semesters. Non-compliance with these regulations will jeopardize your immigration
status and can lead to deportation.
STATEMENT OF FINANCIAL RESPONSIBILITY

Name of Applicant____________________________________________________________
(LAST NAME OR FAMILY NAME) (FIRST NAME)

MTSU Identification number: M____________________________________

International students applying for non-immigrant visas (F-1) are required to certify that they
have sufficient financial resources to cover each year of their intended stay in the United States.
In addition to completing this form, the applicant must provide the University with a letter from a
financial institution validating funds of greater than or equal to US$36,500.

Bank Verification Requirements:


• Document must be written on financial institution’s official letterhead
• Document must be written in English
• Verify actual account balance

I, ____________________________________, certify that I have the following source(s) of funding:


Student Name

Source of Funds
Self/Family $__________________
Official letter form a bank on letter head or financial guarantee from the bank is required.
Government/Embassy $__________________
Letter of sponsorship is required and must show the term you are applying for admission, the academic
major/field of study to be sponsored, and the length of sponsorship

Scholarship/Loan $__________________
Submit official award letter or loan approval form

Graduate Assistantship $__________________


Offer letter must be submitted

Total $__________________
*Total must be greater than or equal to US$36,500.00

Student Attestation:
I have read the information on this form and certify that I have sufficient funds to defray all
expenses mentioned above for the duration of my enrollment at MTSU.

___________________________________________________________
Signature of Applicant/Student (Parent signature required on page three if the student is under 18 years of age)
DEPENDENT FAMILY INFORMATION
Please list the information for all dependents who will need immigration documents issued by
MTSU. Provide the passport biographical page for each dependent, along with a marriage license for a spouse. For
your spouse, add $5,000. For your children, add $2,500 per child.

Child’s Name: ______________________________ Date of Birth: _________________________


Country of Birth: ____________________________Country of Citizenship:__________________

Spouse’s Name: _____________________________ Date of Birth: ________________________


Country of Birth: ____________________________ Country of Citizenship:_________________

Child’s Name: ______________________________ Date of Birth: _________________________


Country of Birth: ____________________________Country of Citizenship:__________________

I do not have any dependents accompanying me.

Estimated Fees

Tuition & fees: $28,264


Room & board: $6,153
Health insurance: $1,359
Books & supplies $724

Total (as stated on I-20 Form): $36,500

Sponsor/Parent information:
By signing as a Sponsor/Parent, you assure that the above named student will not become a public charge while in the
United States. You agree to maintain and support the student financially, for the amount of estimated expenses shown
for the entirety of the students enrollment . You acknowledge that your provided bank statement/financial information
is true and correct, and your funds are readily available for the student’s education.

____________________________________________________________________________
Signature of Sponsor (if different than student)
Parent (if different than student)

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