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 ($41,131.00 USD)#
*Spring *Fall **Summer -- 12 Month Period of Study ($47,272.00 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.
*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
$41,131.00 for a 9-month period of study or $47,272.00 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