Statement Of Resources Form - The University Of Texas At Arlington

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STATEMENT OF RESOURCES FORM
COLLEGE OF NURSING
(to be completed by applicant)
1
. Student Information: Student ID Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Date of Birth (MM/DD/YY): _______/______/______
Name: Family/Last (Surname)_______________________________
First (Given) ____________________________
Give your name as it appears (or will appear on your passport. Your passport and application I-20 name must be the same.
If passport has been issued attach a copy to this form.
2.
Proper completion of this form is required before an I20 (Certificate of Eligibility) can be issued. The U.S. Immigrations and Customs
Enforcement regulations require proof that sufficient funds are available to meet educational and living expenses while in the United States. Thus,
you must submit financial documentation that proves you have sufficient funds to meet one *full year of expenses, as estimated below. Inaccurate
information submitted on this form may result in financial crisis. Please keep in mind that tuition cost is determined by the Texas legislature and is
subject to change without notice.
Tuition:
$15,532.00
Tuition:
$20,821.00
Living:
$12,650.00
Living:
$12,650.00
9 - MONTH TOTAL
$28,182.00 USD
12 - MONTH TOTAL
$33,471.00 USD
**FALL & SPRING applicants are required to submit finances for a 9-month period of study.
**SUMMER applicants are required to submit finances for a 12-month period of study.
3
. Dependent Information: If you will be accompanied by dependent (s) please provide the following information for each individual. You must
add the following amounts to the required 9 or 12 month fund total: (1 person)-$5,000.00 USD; (2 people)-$7,500.00 USD; (3 people)-10,000
USD; (4 people)-$12,500.00 USD. Please note, a dependent is defined as a spouse or child under the age of 21.
Last Name (as on passport)
First Name (as on passport)
Date of Birth
Country of Citizenship
)
mm/dd/yyyy
4.
Source (s) of support: Indicate below the source & amount of financial support. If you have more than one source check as many categories (A
B, or C) as appropriate & list amount.
If you are supporting yourself have your bank complete the Bank Affidavit.
____A.
$_______________
If you are not self-supporting have your sponsor complete the
____B.
Sponsor’s Statement & have the sponsor’s bank complete the Bank Affidavit
$_______________
If you will be sponsored by government, employer, other organization or if you will be supported
____C.
by a scholarship request an award letter stating your name, amount of U.S. Dollars for each
year of study, beginning & ending dates; degree level; and major field of study
.
$_______________
TOTAL OF A, B and C
$_______________
5.
I understand that by submitting this form I certify the following: (1) I will have the minimum listed above for a 9-month period of study or a 12-
month period of Study in U.S. (2) The I-20 amounts listed above do not include travel; I will have adequate funds to travel to and from the U.S. (3) I
will make the necessary arrangements to have all funds transferred to the U.S. (4) I need approximately $6,000.00 in U.S. currency to meet initial
enrollment & housing rental expenses. (5) I must attend a new student orientation program before registering for classes. (6) I will be required to
purchase health insurance. (7) If I choose to enroll in the summer, I understand that the 9 month I-20 does not include tuition and fees for summer
term enrollment. Summer enrollment is optional. I understand that additional funds will be required if I choose to enroll in the summer terms. Please
see the 12 month I-20 amount listed above which includes tuition and fees for summer term enrollment.
Mail to: Graduate School, UTA Box 19167, Arlington TX 76019 OR FAX to 817-272-1494

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