Two Year MBA Financial Certificate

One Semester 2012-2013 Academic Year

This form must be completed and returned to:

Harriet Ruskin

Fax 1.404.712.9648

As an international applicant, you are required to certify that you have sufficient funds to cover your expenses while attending Emory University. Please Note: This form must be completed by every international student who intends to enroll. This includes applicants who are awarded teaching assistantships, research assistantships and other university awards. The admissions process is not complete until this form has been completed and returned to Emory. Visa documents are issued only when all admission procedures have been satisfied.

For One Semester of the Two Year MBA Tuition, Fees and Expenses for 2012-13 are (US Dollars):

Tuition $Waived

Fees $257

Living Expenses $9064 (estimate)

Health Insurance Premiums $1080 (estimate)

Textbooks/Supplies $1050 (estimate)

Subtotal $11,451

Spouse (if applicable)(+$8,400)$

Children (if applicable) (+$4200 per child)$

Total$

A married student with a family will need to show an additional $8,400 per year ($700 per month) for the spouse and $4,200 per year ($350 per month) for each child.

In computing your expenses, you should bear in mind that students holding Students (F)or exchange Visitor (J) visas will not be authorized to work except under extraordinarycircumstances. Therefore, the applicant should not look to employment, either part-timeduring the academic year or full-time during the summer, as a significant means ofsupport while at Emory University. Under no circumstances are students permitted towork full-time during the academic year. Spouses of F-1 student visa holders are notpermitted to work under any circumstances. Please note that your spouse may apply forwork permission only if you hold a J-1 Exchange Visitor visa, and then only for his or herand the children’s support. The spouse of a J-1 Exchange Visitor is permitted to workonly with approval from the U.S. Citizenship and Immigration Service; such approval isnot given routinely.

Name:

LAST (Family) NameFirst (Given) NameMiddle Name

Address:

City and

Country of Birth:

A. Check appropriate box:

  • I plan to come alone
  • I plan to bring the following dependents with me (for each dependent, list: relationship, date & place of birth, nationality, date of issue & expiration date of passport)

Dependent 1

Name:

Relationship:

Date & City/Country of birth:

Nationality:

Date of issue & expiration of passport:

Dependent 2

Name:

Relationship:

Date & City/Country of birth:

Nationality:

Date of issue & expiration of passport:

Dependent 3

Name:

Relationship:

Date & City/Country of birth:

Nationality:

Date of issue & expiration of passport:

Dependent 4

Name:

Relationship:

Date & City/Country of birth:

Nationality:

Date of issue & expiration of passport:

B. I am applying for admission to Emory for: (circle one) FALL SPRING of 201___

Check appropriate box

  • I do not expect to be at Emory for more that one year
  • I expect my program of study to require _____years
  • I expect to remain in Atlanta, during summer periods
  • I expect to attend Summer School Session.

SOURCES OF SUPPORT: Amounts (INDICATE IN U.S. DOLLARS)

Source of Support / Amount in $USD
1. PERSONAL AND /OR FAMILY SAVINGS:
Name of bank:______
Note: A letter from the bank should accompany your statements for the past 3 months. Please see below for the specifications.
2. PARENTS AND/OR SPONSORS:
Print name of each person:
Note: You must provide a letter from each person/sponsor required below OR a bank
certification as above and attach current “original” bank statement to this form.
3. YOUR GOVERNMENT
Print name of Agency:
Note: Enclose with the form a signed letter of award.
4. UNIVERSITY AWARD FROM
Print type of award:
Note: if this is a Goizueta Business School scholarship please attach a copy of your letter
5. OTHER
Please specify:
Note: Enclose a signed “original” affidavit from authorized person to certify accuracy.
6. TOTAL
Note: Must equal or exceed the total amount from the 1st page of this form.

All applicants must show proof of finances. Please obtain an official letter from the bank or financial institution in which you, and/or your sponsor, have available funds. This letter should be written on official letterhead, in English, and signed by a bank official. This letter should state the date the account was open, the currency type, and specifically state an amount this is currently in the account. Additionally the letter should include the average balance for the past three months or the bank official should attach statements for the past three months). Bank letters dated more than two months from the date of submission to (Goizueta Business School) are considered outdated and are not acceptable.

The Total amount of money I expect to have upon arrival at Emory for fees including,

tuition, student fees, transportation, housing deposits and utility deposits is:

U.S. $______

This certifies that the total amount of money that I have available for my semester of

study at Emory University (including funds for spouse and children if applicable) is

US$______

Furthermore, I certify that the above information is correct and complete and that I will

not require additional assistance from Emory University.

Signature of Student:

Date: