2011 Declaration of Finances

Documentation for Student Visa Eligibility Please type or print. *Must be identical to name listed in passport

Please fax this form to the Application Processing Center
at: 607.254.5175.
Attach a copy of passport page and I-20 Address Verification Form.
Student name*: ___________________________________________
(Last/family) (First)
Address: _________________________________________________
_________________________________________________________
_________________________________________________________

Email: ____________________________________________________
Date of birth: _______________

U.S. law requires that we have on file written documentation of financial support for all international students. We must receive this documenta-
tion before we can issue form I-20, which you need to apply for a student visa or to transfer from one school to another within the U.S. Providing
all of the information required on this form—including the signature of your parent or guardian, as well as the signature of an officer of your
bank or other financial institution—will meet that requirement.

Instructions (please read carefully and see reverse side for form to be completed):

1. The amount of support available must total the appropriate bud-
get for each year of study, as shown in the table on the other side
of this form (the relevant figures are in the last row of the table).
2. Your parent or sponsor must sign in the space indicated, under
“Certification.” If you are receiving a government or private schol-
arship, a separate letter may be submitted. It must include the
amount available for tuition, books and supplies, health insurance,
and living and personal expenses, including semester and summer
breaks.
3. From the bank, other financial institution handling your family’s
funds, or your parents’ employer, we must have an officer certify
that, to the best of his or her knowledge, the specified funds are
available for your expenses at Cornell. Having that officer sign the
appropriate space on the front of this form meets our require-
ment. Should the officer prefer, a separate letter may be attached.
This letter must clearly specify the total costs per year (as shown
at the bottom of the table on the back of this form) and must
indicate that, based on the officer’s experience, the stated funds
will be available.
Note: A bank statement listing a current balance or deposits is not
sufficient. If needed, the letter may state that the letter has been
issued for educational purposes and implies no responsibility on
the part of the bank.

2011–12 Estimated Expenses

The following figures are actual expenses (tuition and student-activities fee) and estimated expenses for the 2011–12 academic year at Cornell.
They do not include the cost of travel within the United States or of international travel, because those amounts vary considerably for each stu-
dent. We used these figures as a base for estimating the minimum amounts of total assured support you’ll need for the 2011–12 (first) year and
for subsequent academic years. Those amounts appear in the “Sources of Funds” table on the reverse side. We’ve assumed that the total assured
support required will increase by about 5 percent each year.

Tuition and student activities fee $41,541

Room Fee 7,800
Dining Plan 5,354
Books and supplies* 800
Miscellaneous expenses 1,630
Winter break expenses 1,642
Estimated health insurance 1,716
Subtotal $60,483
††
Transition allowance 900
Total $61,383

*Books and supplies for Architecture, Art, and Planning are $1,320; there is also a $700 facilities fee.
††
This is a one-time settling-in allowance.
Continued on back
2/10 UAO 1K
 2011 Declaration of Finances

Documentation for Student Visa Eligibility Please type or print. *Must be identical to name listed in passport
Please fax this form to the Application Processing Center Student name*: __________________________________________
at: 607.254.5175. (Last/family) (First)
Address: _________________________________________________
Attach a copy of passport page and I-20 Address Verification Form. ________________________________________________________
________________________________________________________

Email: ___________________________________________________
Date of birth: _________________

Note: This financial information is required both to obtain an I-20 (Certificate of Eligibility for a Student Visa) and to apply for a student visa.

See the instructions before completing this form.

Sources of Funds
(see reverse side for base figures and guidelines for estimating expenses)
Please include the sources of support for all years of undergraduate study. The total must be equal to or greater than the total shown below.
Enter all amounts in U.S. dollars.
Assured Support, Projected Support
First Year Second Year Third Year Fourth Year Fifth Year
Your savings or your family’s savings*
Name of bank: __________________________
Your parents or sponsors, or both*
Name: _________________________________
Name: _________________________________
Your government†
Name of agency: ________________________
Cornell University†
Type of award: __________________________
Other‡
Specify: ________________________________

Total $61,383 $63,507 $66,682 $70,016

Total for architecture only $62,603 $64,727 $67,902 $71,236 $74,737

*A bank official must sign below.

†
Enclose a copy of your letter of award, specifying your name, the amount of money available for each year of study, the duration of the award (including beginning and
ending dates), and the major field of study and the degree for which the award is to be used.
‡
Enclose a certificate of the accuracy of this entry. If it is a loan, enclose an official letter from the credit institution, indicating approval of the loan and the amount approved.

Certification
If we receive this form without these signatures, we will return it, which may delay the issuance of your visa.
My signature certifies that I have read the information furnished on this form and that I believe the parent or sponsor is able to provide the funds
indicated above.
Signature of bank official: ____________________________________________________ Date: __________________________________________
Name: ___________________________________________________________________ Title: ________________________________________
Bank: ____________________________________________________________________________________________________________________
name address

My signature certifies that I have read the information furnished on this form, that it is a true and complete statement, and that the funds will be
provided as indicated.
Signature of parent or sponsor: _______________________________________________ Date: __________________________________________
Name: ___________________________________________________ Relationship to applicant: __________________________________________
Address: _________________________________________________________________________________________________________________

My signature certifies that the information on this form is true and complete. Also, I agree to enroll in an approved sickness and
accident–insurance plan for the duration of my study at Cornell.
Signature of applicant: _______________________________________________________ Date: __________________________________________