Office of International Education

Application to Receive Form I-20 or Form DS-2019

and
Need-based Scholarship Application
Form Instructions:
1. You must type information into every box that looks like this “r”.
2. You may need to type information into other boxes that look like this “     ”. Read the instructions in each section
of this form carefully to determine which boxes must be completed.
3. Sometimes, your answer might be “$0”.
4. If your mother and father will support you, they must both sign this form.
5. If either your mother or your father will support you, you must include financial information for BOTH, but only the
supporting parent must sign this form.

Per United States government requirements, applicants for form I-20 “Certificate of Eligibility for Nonimmigrant Student Status” (F-1
status) or form DS-2019 “Certificate of Eligibility for Exchange Visitor (J-1) Status” must provide evidence of ability to pay at least
100% of estimated expenses for the duration of their program in the U.S. Employment while studying in the U.S. cannot be used to
meet this requirement. Scholarships awarded by UW Oshkosh can be used to meet this requirement.

Name (exactly as in your passport):      

Check the box if this applies to you.

I am married, or will be married before I arrive in the U.S. for my studies.
I am financially responsible for       children.
(number)

FAMILY INCOME AND FINANCIAL OBLIGATIONS

Give information about yourself, your father, and your mother PLUS other people who are dependent on your father
and/or mother financially. For example, include your sisters and brothers who live at home, sisters or brothers who go
to a college paid for by your father and/or mother, relatives who live in your father and/or mother’s home, other
relatives that your family assists financially, etc. If you need more space, attach a piece of paper with this information.

Name Relationship Age Estimated Annual Income: this means salary plus income from all other sources
to You Use the currency in which income was earned or expenses were paid.
      Myself n/a Occupation:      
Total Annual Income:       Currency:      
Bank Statement Totals:       Currency:      
      Father n/a Occupation:      
or My father is not living. Total Annual Income:       Currency:      
Bank Statement Totals:       Currency:      
      Mother n/a Occupation:      
or My mother is not living. Total Annual Income:       Currency:      
Bank Statement Totals:       Currency:      
                  This person is in college. and/or My parent assists this person financially.
College Name or type of financial assistance:      
Annual Cost:      
                  This person is in college. and/or My parent assists this person financially.
College Name or type of financial assistance:      
 Annual Cost:      
MONEY COMMITED TO YOUR EDUCATION

You must show a financial commitment FOR EVERY YEAR THAT YOU PLAN TO STUDY AT UW OSHKOSH. This commitment must be
equal to at least the total estimated expenses at UW Oshkosh. Find the total estimated expenses for your studies on our website:
uwosh.edu/oie/iss/ . If you will not study at UW Oshkosh for all four years, answer “$0” for years that you will not be here.

TOTAL ESTIMATED EXPENSES

My First Year US$      My Third Year US$     
My Second Year US$      My Fourth Year US$     

Estimates are based on projected, but not actual, annual increases. Estimates do not include living in the U.S. during the summer,
travel, special course fees or personal expenses. Estimates may be different from actual annual increases.

Instructions:
1. Check a box on the left below IF the contribution type applies to you.
2. If you check a box, you must answer all of the questions in that section, obtain required signatures, and submit all
documentation requested in that section.
3. If you check a box, you must type an amount FOR EVERY YEAR THAT YOU PLAN TO STUDY AT UW OSHKOSH. For any time
period during which there will be no payment, or duing which you will not be at UW Oshkosh, type “$0”.

My Personal Resources
Type the amount that you will pay personally in US dollars. You must provide an electronic or print copy of financial
documents showing that at least the total indicated below has been available for a miniumum of 12 months. If the
statement is not in English, provide a letter from the financial institution confirming the minimum amount of
money that has been in the account for the past 12 months.

My First Year US$      My Third Year US$     

My Second Year US$      My Fourth Year US$     

My Parents’ Contribution
Type the amount that your father and/or mother will pay to UW Oshkosh on your behalf in US dollars. Your parent
must provide an electronic or print copy of financial documents showing that at least the total indicated below has
been available for a miniumum of 12 months. If the statement is not in English, provide a letter from the financial
institution confirming the minimum amount of money that has been in the account for the past 12 months.

My First Year US$      My Third Year US$     

My Second Year US$      My Fourth Year US$     

Parent: I understand that by signing this statement I am obligated to pay the amounts listed above to UW Oshkosh, on
behalf of the applicant, by UW Oshkosh payment deadlines, unless the applicant has paid 100% of his/her University
fees without my contribution. I affirm that my financial documents are authentic and accurate and that the money I
am pledging will be available and accessible as indicated above. I understand that I am obligated to directly notify the
UW Oshkosh OIE (iss@uwosh.edu) if I become unable to fulfil my financial obligation to the University.

Father’s Signature: Mother’s Signature:

Government or Scholarship Organization Sponsorship

Type the amount that a funding ogranization will pay in US dollars. You must provide an original or true certified
copy of your award letter showing at least the total indicated for each time period below.

My First Year US$      My Third Year US$     

My Second Year US$      My Fourth Year US$     

Funding Organization:       Contact Name:      

Address:       Telephone:      
 This organization will: send funding directly to me. Email Address:      
pay UW Oshkosh directly.
Sponsor Contribution (for example, a relative, friend or employer)
Type the amount that a sponsor will pay to UW Oshkosh on your behalf in US dollars FOR EVERY YEAR THAT YOU PLAN
TO STUDY AT UW OSHKOSH. For any time period during which a sponsor will not be supporting you, or duing which
you will not be at UW Oshkosh, type “$0”. Your sponsor must provide an electronic or print copy of financial
documents showing at least the total indicated below. If the statement is not in English, provide a letter from the
financial institution confirming the balance.

My First Year US$      My Third Year US$     

My Second Year US$      My Fourth Year US$     

Sponsor: I understand that by signing this statement I am obligated to pay the amounts listed above to UW Oshkosh,
on behalf of the applicant, by UW Oshkosh payment deadlines, unless the applicant has paid 100% of his/her
University fees without my contribution. I affirm that my financial documents are accurate and that the money I am
pledging will be available and accessible as indicated above. I understand that I am obligated to directly notify the UW
Oshkosh OIE (iss@uwosh.edu) if I become unable to fulfil my financial obligation to the University.

Sponsor’s Name:       Relationship to Applicant:      

Address:       Telephone:      

Sponsor's Email Address:      

Signature:

SCHOLARSHIP APPLICATION
Undergraduate students who will complete a full degree at UW Oshkosh and students studying in the Intensive English
Program are eligible to apply. Scholarships are not available to exchange or visiting students. To apply, attach a 500-
1,000 word original essay addressing 1) your commitment to your own educational development and 2) your
commitment to using your education and skills to contribute to your community.  Demonstrate your commitment by
discussing your extracurricular activities, leadership positions, volunteer work and/or other relevant activities.

Check this box if original financial documents must be mailed back to you for your visa interview.

I understand that I am obligated to pay all tuition & fees due to UW Oshkosh, regardless of the amount I have personally pledged
and regardless of whether my sponsor is able to pay as indicated. I affirm that my financial documents are authentic and accurate. I
understand that I am obligated to notify the UW Oshkosh Student Accounts Office (SA@uwosh.edu) immediately if I become unable
to fulfil my financial obligation to the University.

I understand that international students are subject to the same rules and regulations as domestic UW Oshkosh students. Late
payment will result in finance charges or administrative withdrawal. I understand that administrative withdrawal leads to
enforcement of immigration regulations, requiring that I depart the U.S. immediately.

I understand that falsifying documents or misrepresenting my financial situation will lead to administrative withdrawal.

I understand that most students who work consistently, including summer employment and employment during university breaks,
and accounting for the need to cover minimal summer living expenses, net a maximum of about $3,500 per year. Students who work
consistently but do not stay in the U.S. during summer net a maximum of about $3,000 per year. Off campus employment during the
first year of studying for a degree in the U.S. or while studying in an Intensive English Program is not allowed by the U.S. government.
Students eligible to work on campus must compete for jobs. Anticipated earnings from employment while studying CANNOT be
considered on this application.

I understand that the U.S. Embassy or Consulate may not require original financial documents. Some embassies/consulates require
these and some do not. HOWEVER, I agree to bring ALL ORIGINAL DOCUMENTS that can help me prove that I can pay for my
education to my visa interview. FAILURE TO PROVE THAT I AM FINANCIALLY SECURE will probably lead to visa denial.
Applicant Signature Date