UT Dallas Financial Affidavit for F-1 Students - Texas
UT Dallas / International Student Services / FinAff/ revised 07/07/2014
THE UNIVERSITY OF TEXAS AT DALLAS
International Student Services
800 W. Campbell Rd., SSB34, Richardson, Texas 75080-3021
(972) 883-4189 ISSOCurr[email protected]allas.edu
UT Dallas Financial Affidavit for F-1 Students
Student Name UTD ID Date of Birth
A.
Select the reason for submitting the Financial Affidavit.
F-1 students must provide evidence of financial support for one
academic year in order to receive the types of I-20’s listed below.
Request Initial I-20: Update Current I-20:
⃝
To enter the US
⃝
Update financial information on I-20
⃝
Self
⃝
with Dependents (submit the UT Dallas Financial
Affidavit for F-2 Dependents)
⃝
Change of Level Request
⃝
To Transfer In to UT Dallas from another US Institution
⃝
Program Extension request
⃝
To apply for a Change of Status to F-1
⃝
Add/update dependent information
⃝
To apply for Reinstatement to F-1 Status
(submit the UT Dallas Financial Affidavit for F-2 Dependents)
Other:
B. Student Financial Certification (handwritten signature required
). I certify that the amount of funds indicated in the bank
certification section on this form, or in any submitted financial statements or letters, are available for my academic study at
The University of Texas at Dallas. Additionally, I have sufficient funding to support each year of my education at UT Dallas,
including funds for my spouse and children if applicable.
Student Signature:
Date:
C.
Select the source of your financial support (select all that apply)
⃝
Self. Submit financial documents which list your name as the account holder.
⃝
Sponsors. Submit financial documents which list account holder(s) as your spouse, parents, family, or other individuals.
⃝
UT Dallas Assistantship, Scholarship or Financial Award.
Submit a copy of your award letter OR Assistantship Affidavit Form http://www.utdallas.edu/isso/UTDAward/
⃝
A Business or Government. Submit letter on letterhead.
⃝
Other. Please indicate your source of funding.
D. Sponsor Financial Certification (only required if you have sponsors).
All named account holders must sign and certify
the UT Dallas Financial Affidavit. If you have more than three sponsors, please include an page 1 of additional financial affidavit.
I certify that I am willing and able to financially support the student named on this form for the amount indicated in the bank certification
section on this form, or in the attached bank statement or letter, for every year of their study at UT Dallas.
Sponsor # 1 Name:
Sponsor Signature:
Date:
Sponsor # 2 Name:
Sponsor Signature: Date:
Sponsor # 3 Name:
Sponsor Signature: Date:
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