Financial Resources Statement For
Issuance of Form I-20
PLEASE READ THIS INFORMATION CAREFULLY. FAILURE TO FOLLOW INSTRUCTIONS WILL RESULT IN A
DELAY IN PROCESSING YOUR IMMIGRATION DOCUMENT.
IMPORTANT: All students must complete the worksheet on PAGE 2, including those who have a
sponsorship letter of support. Attach all funding documents to the worksheet and submit with the
I- 20 request form.
If you need an I-20, the University of Michigan School of Public Health is required by U.S. government regulations to
obtain documentation proving that you have adequate financial resources for your expenses and the expenses of your
dependents. You are required to certify the availability of sufficient funds in the form of bank statements and/or proof of
support from a sponsor. MPH/MHSA/MHI is a two-year program. This form is for year one, students will need funding
for both years. Expenses for the second year will increase approximately 5-10%.
**Should your source of funding become available, the University of Michigan School of Public Health is not
responsible for lack of funds due to a sponsor(s) inability to provide support, which could jeapordize a student's visa
status.
Dual Degree: If you are a dual degree student, please note that the School will only issue an I-20 valid up to 2
academic years, the duration of your SPH program. Dual degree students will need to work with SPH Admissions or
your initial admitting unit for an extension during your second year of attendance.
Requirements for Documentation of Funds:


All documents must be in English. If not, an English translation must accompany.
All documentation must be dated within one year from the start of the term (September 5, 2017).
Proof of Support documents that will be accepted (worksheet on page 2 must be completed):
Personal funds from student
Provide bank statement(s) in your name. Bank statements must be no older than September 5,
2016 and clearly show your name. All accounts must be liquid.
 If your funds have a maturity date, they MUST mature by September 5, 2017.

Family or other individual funds
Each individual contributing financially to your education must complete the Affidavit of Financial
Resources and submit an official dated bank statement in their name. In case of jointly held accounts,
each individual holder must complete an Affidavit. Any funds with maturity dates MUST
mature by September 5, 2017.
Financial sponsorship by University of Michigan
 If you recieved a UM-SPH Dean's Award or department award, please include scholarship award
letter/email.
Financial support from Government/Organization/Employer sponsor
 A detailed letter from the sponsor indicating the exact dollar amount being provided, in U.S. funds.
This letter must be on official letterhead and include the dates of sponsorship.
Documents NOT accepted:
 Statements verifying employment and salary
 Insurance premiums and policies
 Property or personal assets (automobiles, land, buildings, jewelry, etc.)
 Lines of credit
 Assets such as stocks, bonds, equities, retirement accounts
 Income tax returns
 Attestations stating only that a sponsor can meet the expenses without providing accompanying
bank statements
Page 1 of 2
Rev
5/07 DP
1/17
1415 Washington Heights  1700 SPH I  Ann Arbor MI  48109-2029
734.763.3860  FAX: 734.763.5455  EMAIL: [email protected]
TEL:
Financial Resources Statement For
Issuance of Form I-20
UMID # _________________
SEVIS ID # (if applicable) N __________________
Uniqname _______________
Name of Student ______________________________________________
Last
First
1.
2.
# of Dependents _____________
All students must fully complete this worksheet prior to submission, to calculate expenses and sources of financial support
(including those who have a sponsor letter, Affidavit of Support, etc.)
Use the exact amounts indicated in the table below.
A. Estimated student expenses for one year.
One Year
Expense
Tuition and Fees – may not be 0
Total
$44,476
$_________
Living expenses
$20,400
$_________
Books & supplies
$1,200
$_________
$1,503
$_________
(Fall/Winter only)
Health Insurance - may not be 0
SUB-TOTAL (A) FOR STUDENT
0
$_________
B. Estimated dependent expenses (in addition to the above estimated student expenses).
One Year
Expense
One dependent living expenses/insurance
$6,885
$_________
Total
Two dependents living expenses/insurance
$11,270
$_________
Three dependents living expenses/insurance
$15,655
$_________
Additional dependents
+ $2,900
$_________
SUB-TOTAL (B) FOR DEPENDENTS
TOTAL (A plus B) ESTIMATED EXPENSES FOR STUDENT PLUS DEPENDENTS
0
$_________
0
$_________
C. Student’s Means of Support.
Personal Funds
$_________
 GSRA/GSI
Funds from U-M
(if applicable)
25% = $11,119
Funds from Family/Sponsor
 Dean's Scholarship (amounts below):
50% = $22,238
75% = $33,357
$_________
100% = $44,476
Specify Source(s): ______________________________
TOTAL AMOUNT OF FINANCIAL SUPPORT (must equal or exceed estimated expenses above)
$_________
0
$_________
Applicant Declaration: I, _______________________, (student’s printed name) hereby certify that the information provided is correct
and that my funding meets the requirements outlined above. I understand I am responsible for all anticipated yearly expenses (and
those of my dependents) for the length of my stay at the University of Michigan.
Applicant signature_____________________________________________ Date_______________________
Page 2 of 2
Rev
5/07 DP
1/17
1415 Washington Heights  1700 SPH I  Ann Arbor MI  48109-2029
734.763.3860  FAX: 734.763.5455  EMAIL: [email protected]
TEL: