Declaration and Certification of Finances

Florida International University
Admissions Office
3000 N.E. 151 St.
North Miami, FL 33181-3000

DECLARATION AND CERTIFICATION OF FINANCES

Please Print:
This document and all accompanying verification must be completed by all international students and returned to the Admissions Office before a student can be considered for admission to the University. Please answer all of the following questions. If a question does not apply to you, write N/A (not applicable) in the blank. An I-20 Form will not be issued until you have been admitted to the University and this form has been approved.

______________________________________ __________________________________ ____________________________
Last Name First Name Middle Name

______________________________________ __________________________________ ____________________________
Birth Place Nation of Citizenship Date of Birth (MM/DD/YY)

Please indicate below where you want your I-20 to be mailed:

_________________________________________________________________________________________________________

____________________________________________________________ Telephone (____)____________________________

Visa Information: If you are not on a F-1 or J-1 visa, please indicate your current visa status and attach documentation (a copy of your current I-94 and the visa page from your passport):

_____ F-2 _____ J-2 _____ A-1 _____ B-1/B2 _____ E _____ H-1 _____ L-1 _____ Other (specify) ______________

Transfer Information: If you are transferring from another U.S. college or university, you must complete immigration transfer procedures upon your arrival at Florida International University. Please report to the Office of International Students and Scholar Services (GC 217) with your new I-20. It is your responsibility to complete this procedure no later than 15 days after your enrollment.

Family Information: What is your family's income per year? U.S. $____________________

How many members of your family are dependent upon this income? ________________

If your spouse or any other dependents will be joining you in the U.S., please list their name, birth date, country of birth, and relationship below:
Name Birth Date Country of Birth Relationship
(MM/DD/YY)

_________________________________________________________________________________________________________

How will you support your dependents in the United States?

_________________________________________________________________________________________________________

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TO BE COMPLETED BY FIU ADMISSIONS OFFICIAL ONLY:

Approved: ______ Denied: _____ Signature: _________________________________________ Date: _________________

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