International Student Financial Background Sheet

Student Last/Family Name: ___________________ First Name: ____________________

Date of Birth: ______/______/__________        Sex:  [  ] Female   [  ] Male  

                          D D      M M         Y Y Y Y  

Nationality: ___________________________________

Student Personal Annual Income ( in US dollars):  $_________________________

Student Father’s Annual Income  ( in US dollars):   $_________________________

Student Mother’s Annual Income  ( in US dollars):  $_________________________

The number of brother and sister of the student applicant: ________________

How many brother and sister do you have who depend on the above income __________

How many brother and sister do you have who are still in school _____________

Student Loan from Bank:                                           $_________________________

(Must attach a letter from bank indicating certain amount of money is secured if student receives a visa to the US. International student on student loan (most from India) must make arrangement to wire the money to school at least 10 days before students flying to school so that school will have enough time to confirm the fund and credit it to student account).

Funding from Government:                              $ _________________________

(Must attach a letter from the government department indicating certain amount of money is secured if student receives a visa to the US)

Funding from Other Organization/Company:    $ ________________________

(Must attach a letter from the organization/company indicating certain amount of money is secured if student receives a visa to the US)

Student Signature: _____________________________ Date: ___________________