First, Last Name

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UNDERGRADUATE GSSP, INTERNATIONAL APPLICANT FINANCIAL DECLARATION A Certificate of Eligibility (Form I-20), for the issuance of a US student visa, CANNOT be processed until you have completed this form, signed the declaration and returned it to GSSP at UNH for processing.

Section 3

NOTE: This form is valid only for students enrolling for the academic year 2017-2018. PERSONAL APPLICANT INFORMATION (please print):

UNH ID (9 Digit ID, enter if available):

Name*: Family Name*

First

Middle

*Print your name exactly as it appears in your passport.

City of Birth:*

Country o f Birth:*

Country o f Citizenship:*

Country of Legal Permanent Residence:*

Date of Birth:*

Current Occupation: e.g. (YYYY-MM-DD)

Mailing Address:* City:*

___ State (Province):

Postal Code:

State (Province):

Postal Code:

Country:* Permanent Address in Home Country:* City:* Country:*

Phone:

E-Mail:

Are you currently in the U.S.? Yes

No

Fax#:

If yes, what is your current immigration status?

REQUIRED FINANCIAL DOCUMENTATION 1.

You are required to document the sum indicated below for 2017-2018, exclusive of travel expenses to and from the U.S. Estimate of Annual Expenses (3-Terms U S $54,060) (l) One-Year IUTP Program

**International students are required to purchase the Student Health Benefits Plan from UNH as a condition of enrollment**

2.

You also need to show financial documentation when you apply for your visa at U.S. Embassy/Consulate, we recommend that you keep a separate set of the original documents. If you are unsure of your source of funding, complete this section to the best of your ability and submit supporting financial documentation when it becomes available. Forms returned to GSSP at UNH without complete financial documentation will delay the issuance of the Certificate of Eligibility (Form I-20) for a US student visa.

3.

Indicate all available funding in the chart below and SIGN THE DECLARATION. All documents submitted MUST BE IN ENGLISH AND U.S. DOLLARS.

**The section listed below should be completed by the person accepting financial responsible as indicated on the financial bank statement**

SOURCE OF FUNDS (Official Documentation Required) PERSON OR FAMILY SAVINGS (Specify)

U.S. Dollars *$

(Attach an original bank statement or a letter written by an authorized bank official on bank stationery. This document must include the account name and number, the amount in U.S. dollars which is available to you for support, and the relationship of the account owner to you.)

U.S. Dollars *$

SPONSORSHIP (Please specify):

(Attach a supporting document or a copy signed by a Notary. Include the name of the source and the amount of funding which is guaranteed to you.)

DECLARATION* I, certify that the above information is correct and complete. I shall notify the GSSP Office of Admissions of any changes in my financial circumstances. I understand that misrepresentation of information is sufficient justification for revoking my acceptance or terminating my enrollment as a student. I understand that electronic submission of this form online constitutes an electronic signature and is legally binding. (Signature Required *)

(Date*)