This is to be completed by both the student and his/her.parent or guarantor.
All signatures must be original and bank statements must be officially
stamped or sealed.
All amounts must be calculated in American (USA) dollars.
All portions of this Declaration of Financial Resources form must be completed before a decision can be made on Your application for admission.
Return completed form to: | RICK HILLMAN, Office of Admissions University of Wisconsin Oshkosh 800 Algoma Blvd., Dempsey 135 Oshkosh, WI 54901-8602 (USA) |
Estimated Expenses for 1996/97 School Year
Tuition and Fees | $8,000.00 |
Living Expenses (Room, Board and Personal Expenses) | $4,600.00 |
Books, Supplies and Insurance | $1.600.00 |
EXPENSES FOR NINE MONTHS: | $14,200.00 |
* If student plans to attend summer school, please add $3,500 to total. ** These figures are not inclusive of travel to and from your home country.
Student's Name: | _____________________________________________________________________ | ||
Last (family) | First | Middle | |
Home Address: | _____________________________________________________________________ | ||
Number and Street | City | Country | |
Mailing Address: | _____________________________________________________________________ | ||
Number and Street | City | Country |
Date of Birth: | ________________________________ | ||
Month | Day | Year |
Desired Visa Status:
___ | Student(F-1) | ___ | Exchange Visitor |
___ | Immigrant | ___ | Diplomat or Official | ___ | Other (specify) |
________________________________________________________________________
________________________________________________________________________
FSFORM . 96 GENERAL INFORMATION
________________________________________________________________
Degree Objective:___________________________
________ | ________ | ________ | |
Month | Day | Year |
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
List all dependents you plan to bring with you:
Relationship | Date of Birth | Nationality |
_____________________________ | ______________ | _____________________________ |
_____________________________ | ______________ | _____________________________ |
_____________________________ | ______________ | _____________________________ |
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Annual Income(USA dollars):____________________
Employer:________________________________________________________
Occupation: ________________________________________________________
Father Deceased: ____________________
Mother's Name:________________________________________________________
Annual Income(USA dollars):____________________
Employer: _________________________________________________________
Occupation: ________________________________________________________
Mother Deceased: ____________________
Sponsor's Name:________________________________________________________
Occupation: ________________________________________________________
Annual Income(USA dollars):____________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Food: | $_______________ |
Clothing: | $_______________ |
Housing: | $_______________ |
Rent/Mortgage | $_______________ |
Taxes: | $_______________ |
Other:(Explain) | $_______________ |
Total | $_______________ |
Explain: _________________________________________________________
Land and Buildings | $_______________ |
Savings | $_______________ |
Investments | $_______________ |
Debts | $_______________ |
Other | $_______________ |
Yes ___ No ___
If yes explain:
________________________________________________________________________
________________________________________________________________________
____________________________ | = | ____________________________ |
Your country's currency | United States Dollar |
Please print (except signatures) |
Assured First Year |
Projected Sources Second Year | Third Year | Fourth Year |
1. Personal and/or family savings: (A bank official's signature below or on an attached letter is required) |
$____________ |
$____________ |
$____________ |
$____________ |
2. Parents and/or sponsors: (Bank official's signature required) Print name of each. | ||||
_________________________ |
$____________ |
$____________ |
$____________ |
$____________ |
_________________________ |
$____________ |
$____________ |
$____________ |
$____________ |
3. Government Sponsor (Print name of agency) | ||||
_________________________ |
$____________ |
$____________ |
$____________ |
$____________ |
4. Other: (Specify below and enclose certification) | ||||
_________________________ |
$____________ |
$____________ |
$____________ |
$____________ |
Parents signature: __________________________________________________
Address: ____________________________________________________________
Date: ____________
Sponsors signature: _________________________________________________
Address: ____________________________________________________________
Date: ____________
Relationship of sponsor to applicant:
___________________________________________________________
Bank official signature:
______________________________________________________________
Name and Address of Bank:
______________________________________________________________
Do you plan to remain in the US during the summer? __ Yes __ No
Do you plan on attending summer school? __ Yes __ No
What are the sources and amounts of support available to you during the summer?
Sources: | ______________________________ | US DOLLARS | __________________ |
Sources: | ______________________________ | US DOLLARS | __________________ |
Student signature ___________________________________________________
Date ____________________________
** Providing false information may jeopardize a student's visa status and furthermore may result in an institution revoking its initial decision to enroll the student.