International Applicant Financial Statement Form - Georgia Institute Of Technology (Page 2 of 2) in pdf

International Applicant Financial Statement Form - Georgia Institute Of Technology Page 2

PAGE 2 of 2

Office of Undergraduate Admission

219 Uncle Heinie Way

Atlanta, GA 30332-0320 (404) 894-4154 Voice

INTERNATIONAL APPLICANT FINANCIAL STATEMENT FORM

Source of Applicant Financial Support (Choose ONE):

___ I will be self-supporting.

___ Other, please list:

Source of Funds (Must Match Attached Financial Documents):

Name of Financial Institution ________________________________________________________________

Address of Institution ______________________________________________________________________

Name of Institution Official _________________________________________________________________

Type of Account __________________________________________________________________________

Total Amount Available in USD for the First Year:

$ ____________________________________

Affidavit of Support:

•

I certify that I have read and fully understand the above.

•

I further certify that I have financial resources to cover all expenses of the student, while in the United

States.

•

I understand that the failure to include any information, including the official financial documents, will

hinder processing of the student’s application.

•

I understand that the inclusion of any false information concerning financial support will be considered

grounds for the student’s dismissal from the Georgia Institute of Technology.

•

A certified bank statement or letter as described above is attached to this form.

__________________________________________

_________________________________________

(Name of Applicant or Sponsor)

(Relationship to Applicant)

__________________________________________

____________________

(Signature of above)

(Date)

Applicant Declaration of Accuracy:

I certify that the information given on this form is complete and accurate to the best of my knowledge. I

am fully aware that any false or misleading information will result in the cancellation of my application

or denial of my potential admission.

__________________________________

_______________________________

_______________

(Name of Applicant)

(Signature)

(Date)

GTID of Applicant:____________________________________________

NOTE: An I-20 cannot be issued without receipt of proper financial documents along with this completed form.

Updated:

January, 2009

International Applicant Financial Statement Form - Georgia Institute Of Technology Page 2

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