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Eastern Michigan University
Financial Statement of Responsibility and Financial Affidavit of Support
(FINR/FASP)
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This form is used for F-1 or F-3 student VISA applicants who are required to certify that they have sufficient funds to cover all
expenses while attending Eastern Michigan University. This form is NOT required for applicants who are a US citizen, permanent
resident or living within the US on another type of VISA for which they are eligible to study at the post-secondary/college/university
level. In those cases, submit a copy of your visa or other immigration documents to confirm your current immigration status.
FAXES, SCANS, OR PHOTOCOPIES of this document will be accepted but accompanying bank statements with live signature or stamp
must be sent through the postal mail.
I. APPLICANT: (please enter name as shown on your passport and include a copy of your passport with this form)
Last Name (Surname/Family Name)
/
First Name (Given)
/
Middle Initial
/ EMU Student number
Applicant’s Home Country Address (required for I-20): (Please print clearly)
Permanent Address Line 1:
Permanent Address Line 2:
City:
Country:
Postal/Mailing code:
Current Immigration/Visa Status:
Gender:
Male
Female
Birth Country:
F-1
Single
Phone number:
J-1
H-4
Married
H-1
Other (please specify):
Date of Birth (mm/dd/yyyy):
Country of Citizenship:
Expected VISA Type:
F-1 (I-20)
F-1: Full-time enrollment required
Degree Sought:
E-mail:
Outside of U.S.
Marital Status:
Province/Region:
Bachelor
F-3 (I-20)
/
/
Birth City:
J-1 (DS2019—see OIS, 244 Student Center, [email protected] )
F-3: Part-time Commuter visa type for Canadian passport holders only commuting within 75 miles of US border
Masters or Cert
Doctorate
Term:
Fall (Sept. - Dec.)
Winter (Jan. – Apr.)
Summer (May- Aug.)
Indicate the program you intend to study (Required for I-20):
Will your spouse or children come with you?
Yes
No
Enter the total number of dependents:
If Yes, include a copy of their passports and complete all information below:
Last Name
First Name
Relationship to
applicant
Date of Birth
(mm/dd/yyyy)
(use additional sheets if necessary)
Country of Birth
Country of Citizenship
Passport Copy
Included (X)
1.
2.
3.
4.
If you are an F/J VISA holder, what is your SEVIS (N) Number? N
SEVIS release date:
/
/
(mm/dd/yyyy)
If on F/J VISA, what US institution are you transferring from?
Transfer students: submit the International Student Advisor Letter http://www.emich.edu/admissions/forms/international_student_advisor_letter.pdf
1
FINR/FASP 8/2015
II. SELECT YOUR ESTIMATED COSTS: The dollar figures in the plans below include costs projected for tuition and fees,
transportation, books, room and board, and mandatory health insurance. Costs are for one academic year for an international student at
EMU using current school year rates. Totals are shown in United States Dollars (USD) for minimum full time enrollment.
(Place an “X” next to your selection)
Plan 1
Plan 2
Fall &
Fall &
F-1 or J-1 VISA Applicants
F-3 VISA Canadian Commuters
Winter
Winter
(full-time enrollment)
(part-time enrollment)
$31,398 F3 Graduate
$18,096
F1/J1 Graduate
F1/J1 Undergraduate
$34,184
F1/J1 Graduate Ph.D
$33,958
F3 Undergraduate
Additional expenses (use the box to the right to add your plan + additional expenses)
- Health Insurance (Optional) Spouse
1,824
- Health Insurance (Optional) Each Child
1,824
- Living Expenses for each additional family member
6,325
$20,669
Add USD figures =>
Plan $
Total Optional HI
$
Total Living
$
Total USD for I-20
Eligibility
$
III. FINANCIAL AFFIDAVIT OF SUPPORT
FAXES, SCANS, OR PHOTOCOPIES OF THIS FORM AND ANY SUPPORTING FINANCIAL DOCUMENTS ARE NOT ACCEPTED
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International applicants must submit a financial affidavit of support with the bank’s seal and original/live signatures to provide proof
of liquid funds equal to or exceeding the “Total USD for I-20 Eligibility” above. Official bank statements may be used to support
Financial Affidavits of Support. Applicants are encouraged to prepare 2 copies of financial documents (1 copy for EMU and 1 copy
for VISA interview purposes.) Only liquid account types are accepted: 1) Cash in savings/checking account 2) Certificates of
Deposits (CD’s) or 3) US based money market account with immediate withdraw into US Dollars
ENTER LIQUID FUNDS IN USD
Applicant’s Financial Support
BANK STAMP HERE
FOR BANK OFFICIAL USE:
VERIFICATION OF LIQUID FUNDS
Amount of student’s personal funds: USD
Amount Verified in USD
Amount of expected EMU funds:
Name of account holder in English and in Native Language
USD
Amount of funds from other sources: USD
Bank official’s name
Specify other sources of funds: (Family, scholarship,
sponsor)
Bank official’s signature
Total Funding:
USD
_
Bank name
_
Title
Date
Bank address
Bank e-mail
AFFIDAVIT OF FINANCIAL SUPPORT FROM PARENT OR SPONSOR:
International Admissions
Eastern Michigan University
401 Pierce Hall
Ypsilanti, MI 48197 USA
I will provide financial sponsorship for the applicant for one academic year in the
amount of
$
_USD
Sponsor Name (print)
Sponsor Signature
Date
The above costs reflect the average cost for 1 year of minimum enrollment and do not include costs for additional credit hours that are not mandatory
per year. Students are responsible for all costs for the entire length of study at EMU as tuition rates and living expenses may increase without notice.
Applicant’s Surname /Last Name / First Name (printed)
Applicant’s Signature
2
Date: mm/dd/yyyy
FINR/FASP 8/2015