autumn quarter 2014 statement of nancial responsibility summer quarter 2014

U.S. immigration law requires that international students show proof of finances for one full academic year before the UW may issue an I-20 or other immigration documents. Please complete the following form and submit it along with your I-20 Request Form, a copy of a bank statement or bank letter showing proof of finances, and a copy of your passport.

STUDENTS NAME

Last (Family) name

First (Given) name

Middle name

|
DATE OF BIRTH

|
Month Day

|
Year

UW STUDENT NUMBER as shown on the Enrollment Conrmation instructions

or at admit.uw.edu/Welcome/International/Connecting.

Quarter of Admission:

Autumn 2014

Summer 2014

Please indicate what type of funding you will receive and the amount in U.S. dollars (check all that apply):

Personal or Family Funds

Please list the name, address, and relationship (parent, spouse, sibling, etc.) of the person providing the funding. If you, the applicant, will support yourself, please write Self in the space below.
First (Given) Name Address Line 1 City Family (Last) Name Address Line 2 (if needed) State/Province/Territory Zip+4 or Postal Code

USD$

Relationship to applicant

Country

Scholarship, Loan, or Agency Funds

Please list below the name of the scholarship, loan, or agency that will provide funds.
Name of Organization providing funds

USD$

Funds from a Private Sponsor

Please list below the name and contact information of the person sponsoring your studies.
First (Given) Name Address Line 1 City Family (Last) Name Address Line 2 (if needed) State/Province/Territory Zip+4 or Postal Code

USD$

Country

Total Funding*

USD$

* Total amount above should be at least $49,296 for students entering the UW autumn quarter or $63,875 for students entering summer quarter. Figures are based on the student budget for 2014-15 except for tuition and health insurance fees. Those fees will be set in July. Go to admit.uw.edu/Welcome/International/Paying for a breakdown of the fees.

I certify that I have sufcient funds for study in the U.S. and that I will be responsible for the total cost of tuition and living expenses for each year of study at the University of Washington Seattle campus.
Student Signature
Universit y of Washington Registrars Processing Center 1410 NE Campus Pk w y 225 Schmit z Hall Box 355850 Seat tle WA 98195 -5850 UW Intl Statement of Fin Resp 2061442/03.11.2014

Date (mm/dd/yyyy)