Financial Certi\ue000ication Statement
for 2009-2010 international students
U.S. Department o\ue000 Homeland Security regulations require that the University maintain records showing that you have met its
fnancial requirements (as well as its academic and language profciency requirements). You are responsible \ue000or demonstrating that
you have su\ue000fcient \ue000unds to meet all educational and personal expenses \ue000or the duration o\ue000 your F-1 status at the University.
You must fll out all the in\ue000ormation on this \ue000orm be\ue000ore the University o\ue000 Minnesota will issue you an I-20. I\ue000 you are a resident o\ue000
Manitoba, Canada, please request the fnancial certifcation statement \ue000or Manitoba residents \ue000rom the O\ue000fce o\ue000 Admissions or download
it at http://admissions.tc.umn.edu/PDFs.
You must certi\ue000y that you have at least the amount necessary to cover your tuition, \ue000ees, and living expenses \ue000or your frst academic year
(12 months). I\ue000 you attend summer session and/or bring your spouse or other dependents with you to the United States, you must certi\ue000y
that you have the additional amount necessary to cover those costs.
Complete this \ue000orm care\ue000ully to avoid lengthy delays that may a\ue000\ue000ect your academic plans. We will return \ue000orms that are
incomplete or that do not show adequate fnancial resources. Do not send bank statements.
1. Undergraduate tuition, \ue000ees,
and mandatory health insurance
\ue000or 2009-2010 academic year
2. Living expenses, including
book expenses, \ue000or 12 months
4. Summer school tuition, \ue000ees,
and health insurance:
$8,661 (i\ue000 needed)
5. Living expenses \ue000or spouse/
children(See back o\ue000 this \ue000orm \ue000or fgures
and requested dependent in\ue000ormation.)
6. Total(Add lines 3 through 5)
7. Personal \ue000unds
8. Family \ue000unds \ue000rom abroad
List name and relationship to you:
9. Scholarship, grant or loan
List name and address o\ue000 source:
10. Funds \ue000rom another source
Speci\ue000y type, source and address:
11. Total (Add lines 7 through 10)
This amount should equal or exceed the total \ue000rom line 6.
List the amount in U.S. dollars that is available
to you \ue000rom each o\ue000 your fnancial resources.
U o\ue000 M ID# i\ue000 known
Form continues on back side\u27a5
Name and permanent address
Permanent addressPlease provide your permanent address in your home country.
(PLEASE PRINT) \ue000irst
last or \ue000amily name
date o\ue000 birth (month, day, year)