WSU International Programs Certification of Financial Status

WSU International Programs Certification of Financial Status Instructions: Describe your situation as it pertains to the following sources of funds...

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WSU International Programs Certification of Financial Status Instructions: Describe your situation as it pertains to the following sources offunds. Add additional pages ifyou need more room than is provided. ASSETS (Income) 1. Previously received or expected Scholarships, Awards, Grants, Assistantships, and Fellowships while at WSU. List amounts for each and when they were (will be) received.

2. Personal funds including checking account(s), savings account(s), stocks, bonds, mutual funds and any other financial instruments, both in the USA and in other countries. List amounts for each.

3. Family funds as described in No. 2 which are available to you for your education. List amounts for each.

4. Net monthly income in USA (attach documentation).

5. Have you filed an income tax return for the past year? __ If so, attach a copy of your tax return. 6. All international students complete a Financial Certification fonn when they first apply for admission indicating adequate financial support to attend WSU. Please state any specific financial circumstances that may have occurred which negatively effected your ability to fund your education as it relates to your original Financial Certification form and/or expected funds in No. 1, 2, or 3 above.

(over) Page 1of2

LIABILITIES (Expenses) 1. Estimated expenses (please complete as appropriate):

Tuition and fees per semester

US$_ _ _ _ _ _ _ _ _ __

Books/Supplies per semester

US$_ _ _ _ _ _ _ _ _ __

Housing costs per semester

US$_ _ _ _ _ _ _ _ _ _ __

Food and household supplies/semester

US$_ _ _ _ _ _ _ _ _ _ __

·Utilities (electricity, water, etc)per semester

US$_ _ _ _ _ _ _ _ _ _ __

Telephone per semester

US$_ _ _ _ _ _ _ _ _ _ __

Clothing per semester

US$_ _ _ _ _ _ _ _ _ __

Medical expenses per semester

US$ _ _ _ _ _ _ _ _ _ _ __

Local Transportation per semester

US$_ _ _ _ _ _ _ _ _ _ __

International transportation per semester

US$_ _ _ _ _ _ _ _ _ _ __

Other costs per semester (list)

US$_ _ _ _ _ _ _ _ _ _ __

TOTAL Costs per semester

0 _ _ _ _ _ _ _ _ _ __ US$_

I certify that the above statements and figures on both pages 1 and 2 of this form and all attachments are truthful, complete and accurate.

WSU Student ID#

Print or Type Name

Signature

Date

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