Financial Statement

for International Students

PLEASE NOTE: It is your responsibility to demonstrate that sufficient funding is available to meet all University expenses. An I-20 or DS-2019 cannot be issued without
this form and the supporting financial documentation. (If you have more than one sponsor, each must be identified and a separate financial statement must be submitted.
Photocopies of this form may be made for completion by each sponsor). Please make copies of all financial documents as you will need them to show proof of adequate
funding to U.S. Consular officials when you apply for a visa.
1.

Student Name _____________________________________________________________________________

PLEASE USE NAME AS IT APPEARS ON YOUR PASSPORT. FAMILY (SURNAME)

FIRST (GIVEN) _____________________________________________________________________________ MIDDLE _______________________________________________

2.

Source of Funds: Please identify the source(s) and amount of funds available. All funds pledged in sponsorship of a student must be veried by a bank statement written
in English on bank letterhead and contain an account number, the amount in U.S. or foreign currency and be signed and dated by a bank ocial no more than six
months prior to the date you apply. Sponsor(s) name must be on the bank statement.

Self-Sponsored Complete the form below indicating yourself as the sponsor. Submit a current bank statement verifying amount
that is available.

Amount (in U.S. dollars)

Family Funds The sponsor must complete the form below. Submit a current bank statement (in Sponsors name) verifying amount
that is available.
Government/Company Sponsor Submit a letter on official letterhead that includes your name and indicates in detail which costs
tuition, fees, room, meal, etc.) will be provided. You must submit additional certification for those costs not provided.
Other (specify) The sponsor must complete the form below. Submit a current bank statement verifying the amount that is
available.

3.

Sponsor: This section must be completed by the sponsor. (In lieu of this form, the sponsor may supply a letter with this information provided. It must be signed by
the sponsor. A bank statement must be included. Sponsors name must be on the bank statement.)

_____________________________________________________________________________________________________________________________________________________
NAME OF SPONSOR (PRINT)

RELATIONSHIP OF SPONSOR TO APPLICANT

_____________________________________________________________________________________________________________________________________________________
COMPLETE ADDRESS

_____________________________________________________________________________________________________________________________________________________
This is to certify that I, the sponsor, ___________________________________________________________________________ will provide funds in the amount of
SPONSORS NAME

at least U.S. $40,690 (for undergraduate) or U.S. $28,130 (for graduate) plus any increase due to ination, per academic year (9 mos.) for tuition, fees, room and board,
and insurance for ________________________________________________________________ . This support will continue for the duration of the program of study. Further,
NAME OF STUDENT

I understand that I am responsible for any and all debts incurred by the student while attending the University of Bridgeport. I am employed as, or engaged in the business
of ____________________________________with ______________________________________________________________ and I derive a net income of U.S. $ ________________
INDUSTRY

COMPANY NAME

annually. Attached is a statement from my bank or other duciary agent attesting to my nancial status. My signature below certies my sponsorship.
Sponsors Signature _______________________________________________________________________________________________ Date _______________________________
TO BE SIGNED BY STUDENT: I certify that the statements given by me in this form are complete and accurate. Furthermore, I take all nancial responsibilities should my
source of funding, as specied above, be interrupted or stopped.
Students Signature _______________________________________________________________________________________________ Date _______________________________

Costs:

The estimated costs for the Fall 2011 and Spring 2012 are outlined below. Estimated increases for the Fall 2012 will be approximately 3-5%.
Personal expenses and travel costs are not included.

ESTIMATED
UNDERGRADUATE COSTS PER YEAR

ESTIMATED
GRADUATE COSTS PER YEAR

ESTIMATED POSSIBLE
ADDITIONAL COSTS

TUITION (AVERAGE 30 CREDITS)................................... $ 25,200

ROOM & BOARD ........................................................... $ 11,700
FEES ............................................................................. $ 3,005
INSURANCE .................................................................. $ 785

TUITION (AVERAGE 18 CREDITS)................................... $ 12,600

ROOM & BOARD ........................................................... $ 12,300
FEES ............................................................................. $ 2,445
INSURANCE .................................................................. $ 785

DEPENDENTS .................................................... $5,850 ...... $6,150

SUMMER ROOM & BOARD (PER MONTH) ........... $ 445 ......$ 445
SUMMER TUITION (PER CREDIT) ....................... $ 610 ...... $ 700

TOTAL SHOWN ON I-20 ......................................................... $ 40,690

TOTAL SHOWN ON I-20 ................................................ $ 28,130

______

UG

GR

______

The above mentioned amounts are per one academic year (2 semesters). International Students will pay over half of the above mentioned amounts upon
registration for their rst semester if they will be living on campus.