International Student Certification of Finances
CONFIDENTIAL
Schreiner University is obligated to obtain accurate information about the funds available to international students who are admitted to
study at Schreiner. Verification of financial resources must be reported on this form for each source of funding. Supporting documents
may also be required. Funds to pay for one-half of the first year’s cost of attendance (in U.S. Dollars) must be deposited in Schreiner’s
Business Office account prior to institutional issuance of Certificate of Eligibility (Form I-20).
Academically capable international students may be eligible for academic/merit scholarships (awarded at time of admission); if
awarded a scholarship, tuition will be adjusted accordingly. The scholarship amount will be noted on this form by an appropriate
Schreiner official and returned to you with your Certificate of Eligibility (Form I-20). Both this form and the certificate must be shown
to the U.S. Consul to obtain a visa.
Student’s Name
Family name
Permanent Address
Date of Birth
First
Middle
Month
Day
Year
Mailing Address (if different from above)
Email Address
Place of Birth (Country)
Country of Citizenship
Enter the amount of annual support you expect to receive from all sources listed below to finance your educational costs. Enter
amounts in U.S. Dollars. Please PRINT all entries. Use an additional sheet of paper, if necessary.
PERSONAL OR FAMILY SAVINGS
Official Certification of Sources and Funds and Amounts: This is to certify that I have read the information furnished by the
applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
A bank official’s signature is required on the certification if the student is partially or totally supported by personal savings.
Name of Bank
Signature of Bank Official/Title
Address of Bank
Date
$
$
$
$
FIRST Year
assured support
SECOND Year
projected support
THIRD Year
projected support
FOURTH Year
projected support
PARENT MONIES (money available from sources other than savings)
Official Certification of Sources and Funds and Amounts: This is to certify that I have read the information furnished by the
applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
Please describe the source of additional monies below:
Mother’s Name
Father’s Name
Signature of Parent /Date
(Parent’s signature is required)
Parent Address
Name of Bank
Signature of Bank Official/Title
Address of Bank
Date
$
$
$
$
FIRST Year
assured support
SECOND Year
projected support
THIRD Year
projected support
FOURTH Year
projected support
SPONSORS/PRIVATE ORGANIZATION and/or GOVERNMENT MONIES (from sources other than parents)
Official Certification of Sources and Funds and Amounts: This is to certify that I have read the information furnished by the
applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
Please describe the source of additional monies below:
Name of Sponsor, Organization, Government
Name and Title of Official
Relationship of Sponsor to Student
Official’s Signature and Date
Address of Sponsor, Organization, Government
What is the present exchange rate of your country’s currency to
the U.S. Dollar? (For example: 3,100 pesos = $1)
Does your government currently impose restrictions on exchange
and release of funds for study in the U.S.? (If Yes, describe
restrictions.)
Do you have a source for emergency funds once you arrive in the
U.S.?
How will you pay for your transportation to the U.S.?
If Yes, name source and amount available in U.S. Dollars
Do you plan to remain in the U.S. during the summer?
What are the sources and amounts of support available to you
during the summer?
If Yes, do you plan to attend summer school?
A Certificate of Eligibility (form I-20) will not be authorized until: (1) this form is completed and returned to Schreiner University;
and (2) one-half of the first year’s cost of attendance is deposited, in U.S. Dollars, in Schreiner’s Business Office.
I certify that the information on this form is true, correct and complete. I understand that any misrepresentation may be
cause for refusing or revoking admission
Signature of Student:
Date:
For Office Use Only
This is to certify that I have reviewed the declaration and attached documents, if appropriate, and
approve issuance of a Certificate of Eligibility.
Signature of College Official:
Title:
Name of Institution:
Address
Date:
Return to:
Office of Admission and Financial Aid
Schreiner University
2100 Memorial Blvd
Kerrville, Texas 77028-5697