Kent State University Financial Worksheet

KENT STATE UNIVERSITY

FINANCIAL INFORMATION WORKSHEET FOR INTERNATIONAL STUDENTS

1. Your name Mr., Ms., Mrs., Miss _________________________________________________________________________________________

I

Family (Surname)

First (Given Name)

Middle Name

PLEASE PRINT YOUR NAME EXACTLY AS IT IS WRITTEN IN ENGLISH AS IT APPEARS ON YOUR PASSPORT IDENTIFICATION PAGE

2. Permanent Address ____________________________________________________________________________________________________

____________________________________________________________________________________________________

3. Mailing Address _______________________________________________________________________________________________________

(If different from your permanent address)

4a. Date of Birth ___________________ 4b. Country of Birth _______________________ 4c. Country of Citizenship______________________

Month

Day

Year

5. Expected Visa Type

❑ Student Visa (F)

❑ Exchange Visitor Visa (J)

❑ Other _____________________________________________

6. Are you currently in the United States with a non-immigrant visa? ❑ Yes ❑ No

If yes, indicate visa type (for example, F-1, F-2, J-1, B-2, etc.): _________________________________________________________________

7. If you answered yes to question 6, do you plan to leave the United States before attending Kent State University? ❑ Yes ❑ No

8. Do you plan to bring any member of your family with you? ❑ Yes ❑ No

Name

Date of Birth

Country of Birth

Relationship to You

9. If yes, please provide the following information for each person who will be accompanying you:

1. Do you plan to apply for a Graduate Assistantship?

❑ Yes

❑ No

2. Will the Graduate Assistantship be your primary source of funding?

❑ Yes

❑ No

Please complete this chart by filling in every row that pertains to your situation and total the amount and provide the documents required.

1. Do you plan to apply for a Graduate Assistantship? ❑ Yes ❑ No

2.Will the Graduate Assistantship be your primary source of funding? ❑ Yes ❑ No

II

Please complete this chart by filling in every row that pertains to your situation and the total amount and provide the document required.

Name and Address

Documentation

Guaranteed Funds

Sponsor/Source

of Sponsor/Source

Required

in U.S. Dollars

Personal savings

Bank Letter

$

Parents

Bank Statement from

$

Parents Account

Relatives and Friends

Bank Statement from

$

their Account

Loans

Official Letter of

$

Certification from

Lending Institution

Scholarship/

Departmental

$

Appointment

Offer Letter

Salary or Study

Official Letter from

Leave Allowance

Employer

$

Your Government

Official letter confirming

Type and amount of

Financial Aid

$

Other

Official letter confirming

amount and type of financial aid

$

Sub-total

$

+ $4,000 for spouse

$

+ $2,000 for each dependent

$

TOTAL

$

This is to certify that I have reviewed Kent State University’s financial Information Worksheet and that the information on this form is true, correct and complete. I understand that any mis-

representation may be cause for refusing or revoking admission.

III

______________________________________________________________________________________________

_____________________________________________________

SIGNATURE OF APPLICANT

DATE

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