Second Year Source of Funds (U.S. Dollars Only)
Fourth Year Source of Funds (U.S. Dollars Only)
TOTAL
______
$_____
$_____
______ $___
$_____
$ ___
$_____
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'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I also understand that falsifying this document could result in my admissions to Kentucky State University being rescinded.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