Fillable Confidential Financial Statement printable pdf download

Confidential Financial Statement (CFS)

After you have been admitted to UCSB and have submitted your Statement of Intent to Register (SIR), upload this

completed form, a copy of your passport personal information page (the page which includes name, passport number,

expiration, etc.), and requested documents to OISS via the Document Upload System. Use your UCSBNetID to access the

system. OISS cannot begin processing your visa until this form and all required documents have been uploaded.

Note: Account statements must be recently issued. Account statements more than 90 days old are not valid.

Student Name: _________________________________________________________________Perm #:_____________

Last (Family) Name

First (Given) Name

Middle Name

 Undergraduate  Graduate

Fall  Winter  Spring

Program Level:

Major:________________________

Start:

Sources of Funding (check all that apply and include supporting documents)

 Personal Funds: Student is financial account holder.

$ _________ USD

Upload: this form, passport page, and recent account statement (stamped or signed by the institution) as ACCOUNT.pdf

 Sponsor Funds: Financial account in the name of family member or friend.

$ _________ USD

Upload: this form, passport page, recent account statement (stamped or signed by the institution)

showing sponsor as account holder as ACCOUNT.pdf. Named account holder must sign this form.

This is to certify that I guarantee I will cover expenses for the above‐named student

during the first year of study at UCSB for the amount equivalent to:

X___________________________________________ ___________

Signature of sponsor/account holder

Date

Name of account holder_______________________________________________

Relationship to student________________________________________________

 Government or Sponsoring Agency: Includes CONACYT, etc.

$ _________ USD

Upload: this form as CFS.pdf, passport page as PASSPORT.pdf, and copy of award letter AWARD.pdf

Name of sponsor agency: _______________________________________________

 UCSB Funding: Includes department support, EAP funds, etc.

$ _________ USD

Upload: this form as CFS.pdf, passport page as PASSPORT.pdf, and copy of award letter AWARD.pdf

Type of support:  teaching/research assistantship  fellowship  other (specify below)

_________________________________________________________

TOTAL AVAILABLE FUNDING FROM ALL SOURCES →

$ _________ USD

For 2016, TOTAL AVAILABLE FUNDING must total at least: $62,590 for undergraduate students

$50,230 for graduate students

NOTE: Students with dependents must verify an additional $4,000 for spouse and $2,000 per child

Student Signature: I certify that the above statements are correct and complete. (Print out to sign, scan to return)

______________________________________________________ ___________

___________________________________

Signature

Date

Using your UCSBNetID, upload this completed form as CFS.pdf , passport page as PASSPORT.pdf, and requested documents as

ACCOUNT.pdf (if more than one, please use ACCOUNT1.pdf, ACCOUNT2.pdf, etc.) and AWARD.pdf (if you have one) to the UCSB

Office of International Students & Scholars via the Document Upload System: https://apps.sa.ucsb.edu/OISS/DocumentSystem

Confidential Financial Statement

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