UT-Arlington Undergraduate Financial Statement for International Students

(F-1 and J-1 Students)

UTA ID Number: _ _ _ /_ _/_ _ _ _ Date of Birth (Month/Day/Year): ____/____/_____

Applicant Name
Last Name (Family Name) First Name Middle Name Other Names which may appear on academic records

Semester of admission: (circle one) Check Only One: -- 9 Month Period of Study ($41,605.00 USD)#
*Spring *Fall **Summer -- 12 Month Period of Study ($54,433.00 USD)#

Proper completion of this form is required before an I-20 (Certificate of Eligibility) can be issued.
Bureau of Citizenship and Immigration Services regulations require proof that sufficient funds are available to meet educational and living expenses for your first year of
study while in the United States. Although you may apply for certain scholarships, funds are limited and should not be relied upon to finance your education. Scholarship
information may be obtained from UTA’s Financial Aid Office, Box 19199, Arlington, Texas 76019, U.S.A or by visiting UTA’s website at www.uta.edu.

Tuition: $25,656.00 Tuition: $38,484.00

Living, Books & supplies $15,949.00 Living, Books & Supplies $15,949.00

9 – MONTH TOTAL $41,605.00 12 – MONTH TOTAL $54,433.00

*FALL & SPRING applicants not wishing summer enrollment are required to submit finances for a 9-month period of study.
*FALL & SPRING applicants wishing summer enrollment are required to submit finances for a 12-month period of study.
**SUMMER applicants are required to submit finances for a 12-month period of study.
#Tuition and Fees for Business, Engineering and Nursing majors may be higher. For additional information concerning tuition and fees please visit UTA’s website at
https://www.uta.edu/uta/tuition.php.

PERSONAL INFORMATION

Country of Birth Country of Citizenship

Foreign Address

For each dependant accompanying the F-1 student to the U.S., please provide the following information for each individual. You must add the following amounts to the
$41,605.00for a 9-month period of study or $54,433.00 for a 12 month period of study base figure for each dependent listed below:

(1 person) -$5,000.00 (2 people) – 10,000.00 (3 people) - $15,000.00 (4 people) - $20,000.00

Last Name, First Name (as listed on passport) Date of Birth Country of Citizenship Country of Birth

STATEMENT OF RESOURCES

Indicate below the source of your funds.

___ A. Student Funds: Submit one or more of these documents to equal the required funds:
• Bank statement for checking, savings and/or other accessible account;
• Certificates of deposit; mutual, stock or bond funds; and/or other accessible funds

___ B. Family or Friends. A sponsor statement and bank documents are required of all sponsors.
The sponsor statement should include the following:
• A statement that the sponsor will financially support the student.
• Student’s name
• Sponsor’s name
• Sponsor’s signature and date
The sponsor must submit one or more of these documents to equal the required funds:
• Bank statement for checking, savings and/or other accessible account;
• Certificates of deposit; mutual, stock or bond funds; and/or other accessible funds

___ C. Private Company. The following items will be required:

• A Statement on company letterhead verifying that the business will financially support the student. The statement should
include the student’s name and the responsible official’s signature and date.
• A bank statement
• A bank letter showing name of sponsor as an account holder for the business.

___ D. Government. An official letter of sponsorship signed by the appropriate government official is required.

I certify that the information provided on this form is true and correct.

Date Signature of Student

 Financial Support Verification

SPONSOR STATEMENT

Unless you are supported by your own savings, immigration documents cannot be issued without the sponsor’s signature. A separate letter from your sponsor and/or the
U.S. Government Form 1-134 (Affidavit of Support) are acceptable substitutes.

I certify that I will make available to (applicant) a minimum of

$__________________USD for each calendar year of studies at UTA.

Sponsor’s Signature: ____________________________________________________________________ Date: __________________________

Sponsor’s Name (please print):

Family/Last Given/First Other

Sponsor’s relationship to applicant: Father Mother Other-specify

Address:

BANK STATEMENT

This is to certify that ____________________________________________________, has funds equivalent to the U.S. currency in the amount of __________________
to meet expenses for the applicant named above. This certificate does not constitute a statement of liability on my part or on behalf of the bank I represent.

Bank Representative’s Signature & Title: _________________________________________________________________________________________

Bank Name & Address: _______________________________________________________________________________________________________

Date: ___________________________ Seal of Bank:

If bank policies do not allow completion of this form, a separate bank letter or affidavit is an acceptable substitute. The letter should be on bank letterhead, signed by a
bank officer, and specifically state the following:

1) Name of account holder;

2) Date account was opened; and
3) Current account balance or specific knowledge that account holds enough funds to meet a minimum of $41,605.00 for a 9-month period of study or
$54,433.00for a 12-month period of study.

Mail to:
The University of Texas at Arlington
Undergraduate Admissions
701 S. Nedderman Dr.
Box 19114
Arlington, TX 76019-0114, U.S.A.

You may also submit online: https://www.uta.edu/admissions/forms/residency-upload-form