Affidavit of Financial Resources

UNIVERSITY OF MICHIGAN-DEARBORN
and Immigration Information
for International Students
ALL INTERNATIONAL APPLICANTS MUST COMPLETE THIS FORM AND PROVIDE DOCUMENTATON AS REQUIRED.

If you will need an F-1 or J-1 visa, the University of

Michigan is required by U.S. government regulations to obtain OTHER (GOVERNMENT, ORGANIZATION,
/

documentation proving that international applicants have INSTITUTION/SCHOOL)

adequate financial resources to provide for their expenses, If you will be supported by a government agency, organization
including dependents, for the duration of their program. You are or institution/school in your home country, the responsible
officer should complete and submit the “funding agency”
/

required to certify the availability of US $44,000 for your

expenses for the first year only, and indicate source(s) of funding
for subsequent years. Tuition, fees and other expenses are
subject to change. Plan for an annual increase of 5% to 10% for
all costs. There are many pre-schools and day-care centers in the
Date of Birth (month/day/year)
portion of the Affidavit of Financial Support, or a detailed letter
from the sponsor, indicating the exact dollar amount for
tuition/fees, living expenses, books and supplies and health
insurance, is also acceptable. This letter must state all the
information requested in the Affidavit of Financial Support to
include the “source of funding” for all study years.

Dearborn area. Depending on type of care, age of child and if this

service is part-time or full-time, the costs range from $55 per
week to $200 per week. Funds may come from a variety of
You are required to certify a total of $44,000 for the first
resources, including personal, government, organization,
year of study. If you do not receive financial assistance
institution and/or school. Your admission will be finalized upon
from the University of Michigan, will you have sufficient
receipt of all completed, signed and dated financial
funds to support your studies? No Yes
documentation forms. Keep copies of all financial documents to
present to the U.S. Consulate when applying for a visa If you are
All International applicants must complete this form and
currently in the U.S. you must attach a copy of your most recent I-
submit the required financial documentation. Providing
20 or DS-2019.
financial information will not affect your chances for
DOCUMENTATION OF FUNDS receiving financial support from the program or
department.
All applicants must complete this form and provide documentation as
required.
Estimated Student Expenses
1. Original documents on official letterhead showing the
exact amount of funds on deposit must be provided. Tuition and Fees for one academic year ......................... $29,500
Notarized copies, photocopies and faxed documents are (Fall and Winter terms as one academic year –
NOT acceptable. Applicant’s name must be indicated on September through April)
all financial documents.
Living Expenses ............................................................... 11,400
2. Letters of attestation stating only that your sponsor can (housing, food, utilities, transportation,
meet expenses are NOT acceptable. Insurance personal items – 12 months)
premiums and policies are NOT acceptable. Books and supplies ............................................................ 1,100

3. All documents must be in English; translations must be Mandatory Health Insurance .............................................. 2,000
signed and sealed by the appropriate government or TOTAL ESTIMATED EXPENSES .................................. $44,000
bank official.
Estimated Dependent Expenses
4. All supporting documentation must be dated within one (in addition to the above estimated student expenses)
year of initial enrollment. If you are currently in the US,
Spouse’s living expenses, not including insurance............ $6,000
you must provide a current bank statement.
First

Each additional dependent’s living expenses, ..................... 2,700

PERSONAL FUNDS not including insurance

If you will be supported by personal funds (self, family or other Mandatory Health Insurance for one dependent ................. 4,000
relatives), complete and submit the “personal sources” portion of the Mandatory Health Insurance for more than one .................. 8,500
Affidavit of Financial Support on the reverse side and a bank dependent (family coverage)
statement for each individual contributing financially to your
education. In case of jointly held accounts, each individual holder
must provide the Affidavit of Financial Support. Together, all funds
must total at least the minimum amount required to meet the “TOTAL
Estimated Expenses” for the first year of study. Bank statements are
Last (Family)

required for the first year of study only. However, you must also
indicate “source of funding” for all study years.
Name
Affidavit of Financial Resources
and Immigration Information
UNIVERSITY OF MICHIGAN-DEARBORN
for International Students
APPLICANT’S PERSONAL INFORMATION (please print clearly)

List U.S. Social Security Number OR UMD applicant number

Name Last (Family)

First (Given)
Current Occupation
Middle
If currently in the U.S., indicate your visa status and include the 11-
Country of Citizenship digit INS number from the 1-94 card. You must attach a copy of your
most recent I-20 or DS-2019.
City and Country of Birth
I I I I I I I I I I I I
Date of Birth (month/day/year) / /
Failure to provide copies will delay the process.

DEPENDENT INFORMATION REQUIRED

Check the Dependent Name Relationship to Birthdate Country of Country of

appropriate item: (last, first) You (month/day/year) Birth Citizenship
1.
☐ I plan to come
alone.
2.
☐ My dependent(s)
will come later.
3.
☐ The following
dependents will
accompany me:
4.

AFFIDAVIT OF SUPPORT FROM PERSONAL SOURCES (FAMILY, FRIENDS, SELF)

Directions: Ask each of your sponsor(s) to complete and sign the Personal Sources section below. This means that if you have multiple
sponsors, each sponsor MUST complete and sign a separate form. If you are supporting yourself, mark the box to indicate the partial or full
amount you are providing to support yourself. Sign the Applicant’s Declaration (next page).

Check one box only Personal Sponsor

Name Last (Family)
☐ I will provide full financial support for the applicant’s educational and
living expenses for the entire length of study at the University of Michigan- First (Given)
Dearborn. As verification that funding is available, I have attached original
bank statement(s). Please indicate applicant’s name on all financial Relationship to applicant
documents.
Address
I will provide full support for spouse and/or children if accompanying
applicant to the United States (please refer to dependent expenses for
calculation).

OR
Signature

I will provide partial financial support. Date

Amount per year: $ _______________________ As verification that

funding is available, I have attached original bank statement(s).

Please complete both sides of this form.

Affidavit of Financial Resources
and Immigration Information
UNIVERSITY OF MICHIGAN-DEARBORN
for International Students
Directions: Please ask your funding agency to complete this form Signature
or to provide an original letter specifying exact dollar amounts
regarding your support.
Date

We,
(name of sponsor) Official Title
hereby certify that we will pay the following expenses for

Address
(applicant)

from
(country)
☐ Tuition and fees $
☐ Living expenses for student $
☐ Health Insurance $ Address where tuition and fees will be billed, if applicable.
☐ Living expenses for spouse $
and children

Study is approved for

(degree)
in Official Seal of Funding Institution (if available)
(field of study)
at the University of Michigan-Dearborn.

Funding is effective from / to /

(month/year) (month/year)

Total award is $ per year for years.

(US dollars)

Applicant’s Declaration

I,
(applicant’s printed name)
hereby promise that the information provided is correct and All graduate application materials must be sent to the
complete. University of Michigan-Dearborn Office of Graduate Studies. All
I understand I ultimately am responsible for all anticipated yearly undergraduate application materials must be sent to the
expenses for the length of my stay in the United States. I University of Michigan-Dearborn Undergraduate Office of
understand that these documents will not be returned to me. Admissions. If you have questions, please contact the program
of study to which you are applying.
Applicant’s
signature

Date