California State University Affidavit Of Financial Support Form
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1
2California State University, Los Angeles
International Office
Affidavit of Financial Support Form
Applicant Information (type or print clearly):
Name (as it appears in your passport). All students must include a copy of your passport biographical page.
Last
First
Middle
Email:
CIN:
Term applying for:
Fall
Winter
Spring
Summer
20
Mailing Address for I-20:
If you want to pick up the I-20, please check this box:
Financial Sponsor Information:
By signing below, the sponsor certifies that sufficient financial resources will be available to cover the
student’s expenses for the duration of his/her studies at Cal State L.A. Attach copy of the bank statement.
Sponsor’s Name (print)
Relationship to Applicant
Sponsor’s Signature/Date
Address of sponsor
City/State
Country
Amount of sponsorship (US Dollars)
$
Check the appropriate program level you are applying to. *Fees are subject to change without notice.
MA/MS/MBA in
Doctorate
ESTIMATED
Undergraduate
Graduate
Credential
Business
(24 units / 12 months)
(36 units / 3 quarters)
(24 units / 3 quarters)
(24 units / 3 quarters)
EXPENSES*
(24 units / 3 quarters)
$38,340*
$36,670*
$36,210*
$41,580*
$54,100*
TOTAL
Dependent Information:
Attach a copy of passport for each dependent listed below. Additional financial support required: $4500 for spouse
and $3000 for each child. Attach additional sheets if necessary.
Family Name
Date of Birth
Country of Permanent
Relationship
First Name
Gender
City/Country of Birth
(as listed in passport)
(MM/DD/YYYY)
Resident/Citizenship
Spouse
Child 1
Child 2
If you are currently inside the U.S., please submit the following:
Copy of your current visa stamp
Copy of your I-94 form
Copy of your I-20 or DS-2019, and Employment Authorization Document (EAD) if any
School currently attending:
SEVIS ID:
Last Date of Attendance:
If you currently hold F-1 or J-1 status, contact your International Student Advisor for transfer out procedures. See attached instructions for more
information.
Applicant’s Signature:
I certify that all information given above is true and correct. I certify that sufficient financial resources will be available to cover all
expenses for the duration of my studies at Cal State L.A. Further, I agree to be responsible for all expenses not covered by the sponsor
and to obtain and maintain adequate health insurance coverage throughout enrollment at Cal State L.A.
Signature _________________
______________________________ Date: _________________________
Revised 07/2014
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