International Student Financial Statement

INTERNATIONAL STUDENT FINANCIAL STATEMENT

(International Applicants only)

All international applicants must submit proof of finances which must include evidence of support for four (4) full years of study for freshmen and three (3) full

years for transfers. Rensselaer, in compliance with U.S. immigration regulations, cannot issue immigration documents until academic admission requirements have

been met and the International Student Financial Statement is submitted. Once you have completed both pages of this form, mail to Rensselaer Admissions.

Please note: Financial assistance is not available for undergraduate international students.

Full legal name ____________________________________________________________________________________________________________________________________

(as it appears or will appear on your passport)

Last Name/Surname

First/Given

Middle

Mailing address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

City ________________________________________________ Country __________________________________________ Postal code ____________________________

Home telephone ____________________________________________________________________ Fax ________________________________________________________________

country code/city code/number

country code/city code/number

E-mail address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Part I

Answer questions 1-8 completely.

Part II

In the first column, indicate the source(s) of your educational financial support. In the columns headed Year 1, 2, 3,

and 4, indicate the amount (in U.S. dollars) available for each year of study. Each sponsor must verify these amounts

by signing this form under “Verification”.

Be sure to include supplementary documents and attach originals of all supporting documents. These documents

must be dated within twelve (12) months of the date of initial enrollment at Rensselaer.

Included on this statement is an estimate of annual educational and living expenses for international students at

Rensselaer. You must document financial support in an amount equal to or greater than this estimate. Please note

that this is an estimate and is subject to change.

Sources of Funds

Required Documentation

Personal/Family

Signatures of yourself or family members are required. Bank verification must be noted on this form and included

in separate statement of accounts. This separate statement must be an original letter stating the specific amount

verified and signed by a bank official.

Scholarship/Loan

Official scholarship or loan letter must be issued by the institution or organization awarding the scholarship or

issuing the loan. The letter must include the name of the applicant, the amount of money awarded or loaned for

each year of study, the duration of the scholarship or loan (including beginning and ending dates), and the degree

and major for which the scholarship or loan is being issued.

Government/Employer

Official scholarship letter from your government or employer must be issued stating the name of the applicant,

the amount of money awarded for each year of study, the duration of the scholarship or loan (including beginning

and ending dates), and the degree and major for which the scholarship or loan is being issued.

Rensselaer reserves the right to require additional financial documentation and/or pre-payment from any applicant whose country imposes currency

exchange restrictions or other obstacles to the transfer of currency or payment of educational expenses. Applicants from such countries will be notified

of specific requirements when they have submitted complete applications.

Return this form with all additional financial documentation directly to Rensselaer Admissions, Undergraduate Programs, Rensselaer Polytechnic Institute,

110 8th Street, Troy, NY 12180-3590

.