2018-2019
UGA Certificate of Finances for F-1 and J-1 visas / The University of Georgia
Intensive English Program
Division of Academic Enhancement
Athens, Georgia 30602-1554 USA

The University of Georgia requires a statement of finances from students requiring an F-1 or J-1 visa for their studies. This may include but is not limited to those students who are not citizens of United States or in the process of becoming legal permit residents. Dependents of F-1 and J-1 students can study part-time, up to 16 hours a week. (Dependents hold an F-2 or J-2 visa.


An I-20 form is issued by UGA to admit students requesting F-1 student visa sponsorship and a DS-2019 is issued to admit students requesting J-1 student visa sponsorship. This Certificate of Finances and the required supporting bank statements or documents must be on file before an I-20 or DS-2019 form can be issued. Please complete the financial statement on page 3 of this application form and attach recent or certified copies of your current bank statement(s). In order to be considered for admission to the Intensive English Program, please include these materials before the deadline for application for admission. If your source of financial support is from personal or family funds, you must attach an original or certified and current bank statement(s). If the cost of your education is being assumed by a sponsor, the sponsor must provide an original or certified and current bank statement(s) showing the availability of funds. Also include a photocopy of the first page of your passport.
Two original sets of the supporting financial document should be obtained. One set should be emailed to the IEP at and will become part of your permanent file. The other set should be used to present to the US Embassy or Consulate. You must take original forms. Photocopies or faxes are NOT accepted by the US Embassy or Consulate.

*Note: Financial Information provided must be accurate and dated within the last three months.

Part I. Applicant Information — PLEASE PRINT NAME AS IT APPEARS IN PASSPORT

Applicant’s Family Name: ______First Name: ______Middle Name: ______

Foreign Mailing Address (required): ______

______

Postal Code: ______Phone Number:______Applicant’s email address______

United States Mailing Address (if applicable): ______

______

Date of Birth: ______/______/______Marital Status: Single___Married___ Other (specify)______

month day year

Country of Birth: ______Country of Citizenship: ______

Top of Form

Requested Visa Type: ☐ F-1_____ J-1____ ☐ None needed (attach explanation and documentation)

Bottom of Form

Part II. Dependent Information

Will a spouse and/or children be included on your visa? ☐Yes _____ ☐ No _____

If yes, please provide the following information for each: full name, country of birth, date of birth, relationship to you (ex: spouse, son or daughter). Also consult the Cost of Dependents table on this page for the additional costs to be included in the financial statement you provide.

Name
(Family name, Given name) / Date of Birth
(Month/Day/Year) / City of Birth / Relationship
(Spouse, son, etc.)

What is the present exchange rate of your current to the U.S. Dollar (ex: 4 francs = $1)? ______

Does your government currently impose restrictions on the exchange or release of its currency for study in the United States? ☐Yes ___ No___ If yes, describe the restrictions: ______

Please check all sessions for which you plan to apply:

□ Spring 1 □ Spring 2 □ Summer (8wks) □ Summer (4wks) □ Fall 1: □ Fall 2:

Total for
Session 1 / Total for Session
1 & 2 / Total for Sessions
1,2, & 3 / Total for Sessions
1,2, 3 & 4 / Total for Sessions
1,2, 3, 4 & 5 / Cost for Dependents
(add to total cost)
Tuition Fees and Books / 2,300 / 4,600 / 6,900 / 9,200 / 11,500 / For a spouse:
add $800 per session
Room and Meals / 2,000 / 4,000 / 6,000 / 8,000 / 10,000 / For each child:
add $500 per session
Insurance and ISCF Fee / $250 / $500 / 750 / 1,000 / 1,250 / For a spouse and child: add $1,300 per session
TOTAL / $4,550 / $9,100 / $13,650 / $18,200 / $22,750

The figures in the table show the amount of support you must provide for each 8-week session.

Costs for a short (4-week) summer session are in the table below)

One Summer Short Session (4 Weeks) Two short sessions are available in summer: one in June and one in July
Tuition, fees and books ($1150), Room and meals ($1000), insurance and ISCF ($150) / TOTAL $2300

The figures in the table are based on two people sharing a room in an economy apartment. If you want your own private apartment, you may have to pay more for housing.

There is a four-week break between Spring 2 and Summer, a 2-week break between Summer and fall, and a 4-week break between Fall 2 and Spring 1 . The above estimate of costs does not include these breaks. Please remember that you will need to pay for rent and food during these breaks. We also strongly recommend that you purchase medical insurance to cover the breaks between the sessions.

Part III. Financial Support

Please check the category or categories below that describe(s) who will be financing your education and fill in the blanks. Also be sure to attach original or certified and current bank statement(s) to this form:

*Note: Financial Information provided must be accurate and dated within the last three months.

______I will be self-supported ______I will be sponsored by a family member(s)

______I will be sponsored by another individual(s)

I, ______, certify that I have read and fully understand the above financial statement.

(Sponsor or Sponsors)

I further certify that I have financial resources to cover all expenses of ______, while he or she is in the United States. An original bank statement in English reflecting a continuous balance sufficient to cover the cost of attending The University of Georgia Intensive English Program in US currency is attached to this form or will be submitted soon.

I understand that the inclusion of any false information concerning financial support will be considered grounds for the student’s dismissal from the University of Georgia.

______

Signature of Student Signature of Sponsor Signature of Sponsor

Relationship to Applicant ______Date ______

*US $ Amount provided by Student: $______

*US $ Amount provided by Family: $______

*US $ Amount provided by the Sponsor: $______

*Note: Financial Information provided must be accurate and dated within the last three months.

This is to certify that the information included on this form is complete and accurate to the best of my knowledge. I am fully aware that any false or misleading statements will result in automatic denial of my application for admission.

______

Applicant’s Signature Date

Return this form with SUPPORTING BANK STATEMENTS at least two months before your planned program start date. An I-20 or DS-2019 form will not be issued without this completed form and a bank statement in English. (Emailed copies are acceptable)

PLEASE EMAIL COMPLETED FORM AS AN ATTACHMENT TO:

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