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KENTUCKY STATE UNIVERSITY Declaration & Certification of Finances (For International Students Only)
A Certificate of Eligibility (form I-20 or DSP-66) will not be authorized until this form is completed and returned. When all admissions criteria have been appropriately met for Graduate Studies, a copy of this form will be attached to the Certificate of Eligibility. Both must be shown to the U.S. Consulate for issuance of the Visa.
*ESTIMATED GENERAL EXPENSES FOR THE GRADUATE STUDENT * 2009-2010 ACADEMIC YEAR (FALL AND SPRING SEMESTERS)
| Tuition @811 per credit hour x 9 credit hours or Full-Time | 811 x 9 x 2(semesters) | 14,598 per year |
|---|---|---|
| Books and Supplies | 1,200 per year | |
| Personal Expenses 3,500 deposit +2,000 for 2 semesters | 5,500 per year | |
| Miscellaneous (Includes Transportation) | 1,310 per year | |
| TOTAL COST PER ACADEMIC YEAR | 19,108 | |
| *Travel Cost Will Vary | ||
A confirmation deposit of $3,500 (US) is sent to the Office of Graduate Admissions. A student may use a maximum of 65% of the $3,500 deposit to pay the first semester's tuition and fees. The balance will remain on account until the student graduates or withdraws from Kentucky State University.
**ALL FEES SUBJECT TO CHANGE WITHOUT NOTICE**
| Family Name | First Name | Middle Name | ||||
|---|---|---|---|---|---|---|
| Complete Street Address | ||||||
| Complete Street Address (cont'd) | ||||||
| City | Province | Country | Zip Code | |||
| Major | Date of Expected Graduation | |||||
| Birth Date | Country of Birth | |||||
| Intended enrollment at KSU | Fall | Spring | Summer | Year | ||
OFFICIAL VERIFICATION OF SOURCES OF FUNDS AND AMOUNTS
First Year Source of Funds (U.S. Dollars Only)
- $3,500 initial deposit $
- Student’s Personal Funds $
- Funds from Family $
- Funds from another source (please specify) $
TOTAL
$_____
Second Year Source of Funds (U.S. Dollars Only)
- Student’s Personal Funds
- Funds from Family
- Funds from another source (please specify)
- TOTAL
- Third Year Source of Funds (U.S. Dollars Only)
- Student’s Personal Funds
- Funds from Family
- Funds from another source (please specify)
TOTAL
Fourth Year Source of Funds (U.S. Dollars Only)
- Student’s Personal Funds
- Funds from Family
- Funds from another source (please specify)
TOTAL
______
$_____
$_____
______ $___
$_____
$ ___
$_____
CERTIFICATION
This is to certify that I have read the information furnished by the applicant on this form and that it is true and accurate. The above funds are available.
BANK OFFICIAL
| Bank Official's Signature | Date | ||
|---|---|---|---|
| Official Title or Position | Phone Number | ||
| Complete Street Address | |||
| City | Province/State | Country | Zip/Postal Code |
| Notary Signature | FAMILY OR FRIEND | ||
| Family and/or Friend(s) Signature | Date | ||
| Relation | Phone Number | ||
| Complete Street Address | |||
| City | Province/State | Country | Zip/Postal Code |
I certify that the above information is true and correct; I also understand that falsifying this document could result in my admissions to Kentucky State University being rescinded.
Signature of Applicant
Date