The Declaration And Certification Of Finances (Page 3 of 4) in pdf

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The Declaration and Certification of Finances (DCF) Form

Cleveland State University

Office of International Admissions

2121 Euclid Ave. UN 350

Cleveland, Ohio 44123

Fax: 216-687-5449

Who needs to complete this form? International students applying for F-1 student status must complete both

pages 1 and 2 of this form and submit it along with their supporting documentation to the Graduate

Admissions Office.

Please answer ALL of the questions. If a question does not apply to you, please write N/A (not

applicable) in the blank. A SEVIS I-20 will not be issued until you have been admitted to the University

and this form has been approved.

CSU ID:__________________

Please list both your local and foreign addresses below: A foreign address is REQUIRED by DHS/ USCIS.

PLEASE INDICATE ABOVE  WHICH ADDRESS WE SHOULD USE TO MAIL YOUR

SEVIS I-20.

VISA INFORMATION:

All Applicants - Please indicate the visa status you are applying for: F-1 Student J-1

Exchange Visitor

Applicants in the United States only

- Please indicate your current visa status and attach documentation (a copy of your current I-94 and the

visa page from your passport): F-1 F-2 J-1 J-2 A-1 B-1/B-2 E H-1

L-1 Other (specify) _________________

-If you are not in F-1 status, do you plan to return to your home country to apply for the F-1/J-1 visa?

Yes No

If you answer no, you must contact CSU-Center for International Services and Programs at (216)

687-3910 concerning procedures to apply for a change of status.

DEPENDENTS: If your spouse or any other dependents will be joining you in the U.S., please list their name, birth

date, country of birth, and relationship (i.e. husband, wife, daughter, son) below. You must attach documentation

showing financial support for your dependents ($3,500 for your spouse and $2,000 for each child):

Name

Address in Home

Birth Date

Country of

Relationship

(Month/day/year)

(Last name, First Name)

Country

Birth

Citizenship

(wife, son, etc)

(DCF Form: Page 1 of 2)

Revised 04/18/2012

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