Affidavit Of Support
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1
2Affidavit of Support and Proof of Funding
International Services is required by U.S. federal regulations to obtain evidence that academically admitted
applicants have current financial resources available to support themselves during the first year of study at LSU.
Before receiving a Certificate of Eligibility (I-20 or DS-2019), students and/or their sponsor(s) must complete this
form and submit proof of funding. For a list of acceptable types of funding, see Part C of this form. For a list of
the current estimated expenses, visit
PART A:
Student information
(type or print clearly)
LSU ID (if known): ____________________ Application Term (check one): □ Fall □ Spring □ Summer 20_____
Surname: __________________________________ Given Name(s): ____________________________________
*Please include a copy of your passport name page (if you have one). Your name on the I-20/DS-2019 should match your passport.
Date of Birth: ______ / ______ / _________
Gender (circle one):
male
female
MM/DD/YYYY
Citizenship: __________________________ City & Country of Birth: ____________________________________
Foreign address (required):
Street: _________________________________________________________ City: ______________________
Province/Territory: _____________________ Country: _________________________ Post code: __________
Are you in the United States? (circle one):
No
Yes*
*If yes, please include a copy of your current U.S. visa stamp & I-94 ( ). NOTE: If you are in F-1 status with OPT
authorization, please also submit a copy of your Employment Authorization Document (EAD).
PART B:
Dependent information
(type or print clearly; complete only if your dependents will accompany you now)
If your husband, wife or children will come to the U.S. as your F-2 or J-2 dependent(s), you must provide proof of
financial resources for their support ($4,500 per dependent per year) in addition to the amount needed for
yourself. If your dependents have their passports, please submit copies of their passport name pages.
□
If you do not have dependents and/or will come to the United States alone, check here
.
Citizenship and
Relationship
Birth Date
Surname
Given Name(s)
Country of Birth
to you
(mm/dd/yyyy)
□
husband
□
wife
□
son
□
daughter
□
son
□
daughter
□
son
□
daughter
SCO 6/24/16
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