This formmustbe completed andreturned to:
The Goizueta Business School ofEmory University
Admissions Office
1300Clifton Road,NE SuiteW288
Atlanta, GA 30322
Fax: 404.727.4612
Email:
Attn: PamLewis
As an International applicant, you are required tocertify thatyou have sufficient fundsto coveryour expenses while attendingEmory University. Please Note:This formmustbe completed by every international student who intends to enroll. The admissions process is notcomplete until thisform hasbeen completed and returned to the admissions office. Visadocuments are issued only when all admission procedures have been satisfied.
TwoYear MBATuition,Fees and Expenses for2017-18 are:
Tuition$59,000
Fees$616
LivingExpenses$19,278 (estimate) Health Insurance Premiums$3200 (estimate) Textbooks/Supplies $1275 (estimate) Transportation(Parking) $954 (estimate) OneTime Transcript Fee $70
Subtotal$84,393
Spouse(ifapplicable)(+$8,400)$ Children (if applicable)(+$4200 perchild)$
Total$
A married student with a family will need to showanadditional $8,400per year ($700 per month) for the spouse and $4,200 per year ($350 per month) for each child.
In computing your expenses, you should bearinmind that students holding Students(F) or exchange Visitor (J) visas will notbe authorized to work exceptunder extraordinary circumstances. Therefore, the applicant should not look to employment, either part-time during the academic yearor full-time duringthesummer, as a significant means of support while at Emory University.Under no circumstances are studentspermitted to work full-time during the academic year. Spouses of F-1 student visa holders are not permitted towork under any circumstances.
Name:
Last (Family) NameFirst(Given) Name
Middle Name
Address:
City and
Country of Birth:
A. Checkappropriate box:
oI planto come alone
oI planto bring the following dependents withme (for eachdependent,list:
Their relationship to you,their date & place of birth, nationality, date ofissue & expiration date ofpassport)
Dependent 1
Name:
Relationship:
Date &City/Country ofbirth: Nationality:
Date of issue & expiration ofpassport:
Dependent 2
Name:
Relationship:
Date &City/Country ofbirth: Nationality:
Date of issue & expiration ofpassport:
Dependent 3
Name:
Relationship:
Date &City/Country ofbirth: Nationality:
Date of issue & expiration ofpassport:
Dependent 4
Name:
Relationship:
Date &City/Country ofbirth: Nationality:
Date of issue & expiration of passport:
B. I am applying for admission toEmory
Check appropriate box
oI do notexpectto be at Emory formore thanone year
oI expect myprogramof study to require years
oI expect to remain in Atlanta, duringsummer periods
oI expect to attend Summer School Session.
SOURCESOF SUPPORT: Amounts (INDICATEINU.S. DOLLARS)
Source of Support / Amount in $USD1. PERSONALAND /OR FAMILY SAVINGS:
Name of
bank:
Note: A current statementfromthe bank shouldbe from the past3 months. Please see below for the specifications.
2. PARENTS AND/OR SPONSORS:
Printname of each person:
Note: You must provide a letter from each person/sponsor requiredbelow OR a bank certificationas above and attach current “original” bank statement to this form.
3. YOURGOVERNMENT
Printname of Agency:
Note: Enclose with the forma signed letter of award.
4. UNIVERSITYAWARD FROM
Printtype of award:
Note: if thisis aGoizueta Business School scholarshippleaseattach a copy of your letter
5. OTHER
Please specify:
Note: Enclose a signed “original” affidavit
Statement from theauthorized persontocertify accuracy.
6. TOTAL
Note: The total amount must equalthe total amount frompage one of this form.
Totalamount ofmoney you expecttohave upon arrival at Emory (Tuition,Fees, UniversityRoomRentdue atregistration): U.S.$
All applicants must show proof of finances. Please obtain anofficial bank statement from the financial institution inwhich you, and/or your sponsor, have available funds. This letter shouldbe written on official letterhead and in English. This letter should state the datethe accountwasopen, the currency type,and specifically state an amount this is currently in the account. Additionallythe lettershould include the
Average balance for the pastthree monthsor the bank officialshould attach statements for the past three months). Bank lettersdated more than two months fromthe date of submission to (GoizuetaBusiness School)are considered outdated.
This certifies thatthe total amount ofmoney thatI have available for myfirstyear of study atthe Emory University (includingfunds for spouse and childrenif applicable) is
$USD
Furthermore, I certify that theabove information is correct and complete and thatI will not require additional assistance from Emory University.
Signature of Student:
Date: