Seal and signature of Notary Public
or Government Official or
Administer of Oaths
Office of International Student Services
8700 NW River Park Drive
Parkville, MO 64152-3795
Tel. (816) 584-6834, 6379
Fax (816) 505-5443
AFFIDAVIT OF SUPPORT FORM
Affidavit of support for _________________________________________________
(Full Name of Applicant)
This document must contain all of the appropriate signatures and notarizations before a prospective
student application is considered for admission to Park University. Supporting bank statements and/or
other financial documents must be submitted with this document.
The affidavit and supporting bank statements must be dated within 6 months of submitting your
application for admission.
Statement from Family or Sponsor
I, _________________________________, commit to providing financial support to the above
named individual for their duration of studies, whose relationship to me is _________________.
The exact nature and amount of my support is as follows:
Tuition: ___Yes ___No Room/Food: ___Yes ___No Books: ___Yes ___No
Health Insurance: ___Yes ___No Personal Expenses: ___Yes ___No
Total Amount per 12-month Period: __________________
I understand that the University will not be able to assist the prospective student financially
(unless specified otherwise), and I, the undersigned, understand that I am fully responsible and
accountable to the University, for maintaining the terms and statements of this form.
(sign only in presence of Notary)
__________________________________ __________ ____________________________
Family/Sponsor Signature Date Email address/telephone