Download Financial Responsibilities form

SAN JUAN COLLEGE
CERTIFICATION of FINANCIAL RESPONSIBILITY
This form is valid during your course of study. NOTE: This form is not an application for admission, but is required supplementary
information. A form I-20 (for the issuance of the F-1 Visa) cannot be issued to you until you have been admitted to San Juan College
AND have completed this form to our satisfaction. We require you certify that you will have the estimated sum to cover the
expenses for each and every year of study at San Juan College exclusive of travel expenses.
NAME (as it appears on your passport):
____________________________________________________________________________________________________________
Last or Surname
First or Given
Middle Name
Suffix
COUNTRY OF CITIZENSHIP: ____________________________________________________________________
DATE OF BIRTH: _______________________________
COUNTRY OF BIRTH: _________________________
I plan to come without qualifying dependents (qualifying dependents are a spouse and/or children).
The following qualifying dependents will accompany me:
NAME
DATE OF
BIRTH
COUNTRY OF BIRTH
COUNTRY OF CITIZENSHIP
RELATIONSHIP
The applicant must document support (in U.S. Dollars) equal to or greater than the amounts indicated below. These figures are
the estimated costs per calendar year (12 months) and are subject to increase without notice:
Financial Obligations
Fall
Spring
6,241.50
6,241.50
Fees- 18 credit hrs. max $305
305
305
Books/Supplies
600
600
4,200
4,200
550
550
Tuition-18 credit hrs. max/ $346.75 per credit hour
Room/Board
Transportation
Miscellaneous
Totals
675
675
$12,571.50
$12,571.50
In computing your expenses, you should bear in mind those students holding Student (F-1 or J-1) visas are authorized to work only
under limited circumstances. Therefore, the applicant should not look for employment as a means of support while at SJC. Under
no circumstances are students permitted to work full-time during the academic year. If you are an applicant and plan to bring a
spouse and children, a proportionately larger amount must be certified on the basis of at least an additional $5,000 per academic
year for your spouse and $2,500 for each child. Spouses of F-1 student visa holders are not permitted to work under any
circumstances.
Updated 2/7/2014
SOURCE OF FUNDS
REQUIRED VERIFICATION
PERSONAL/FAMILY SAVINGS
Signatures of sponsors on this form. Bank verification in a separate statement of account.
Bank verification must be an original and must demonstrate the funds available
(in U.S. dollars) for the first year of study. Investment portfolios, mortgage appraisals, and
similar statements are not acceptable.
SCHOLARSHIP
Official scholarship award letter from the institution awarding the scholarship. The award
letter must contain:
 Name of applicant
 Amount of money available (in U.S. dollars) for each year of study
 Duration of the award (including beginning and ending dates)
 Requirements of the award
 Degree and major field of study for which the award is tenable
 Name of San Juan College as the institution to which the award is applicable
GOVERNMENT
Official letter indicating amount of support and containing the same information as for
“Scholarship” described above.
LOANS
Official letter from credit institution indicating approval of the loan and the amount approved
(in U. S. dollars).
You are likely to need documentation to prove to the United States Consular and USCIS officials, upon entry to the U. S., that you
have sufficient funds. We suggest you request additional sets of originals of your financial documents for this purpose.
SOURCE OF FUNDS
Personal Savings
REQUIRED VERIFICATION
Original bank statement/letter
Name of Bank: _____________________________________
Account Holder: ____________________________________
Family/Relative Sponsor
Original bank statement/letter
Name: ____________________________________________
Name: ____________________________________________
Scholarship Awarded by (check one of the following):
Fulbright
Other
Government/Employer/Other
Name of Sponsor: ___________________________________
Official award letter
Loan Approval form
Official letter of support
Official bank statement, affidavits, or sworn statement
The amount of $ __________________ (in U.S. dollars) will be available for each and every year of my
studies at San Juan College.
This is to certify that I, the undersigned, have agreed to provide the funds indicated above to the applicant for the purpose of fulltime study at San Juan College, ant that I am submitting the required verification indicating the availability of these funds.
_____________________________________________ __________________ ________________________________________
Sponsor’s Signature
Date
Relationship to Applicant
_____________________________________________ __________________ ________________________________________
Sponsor’s Signature
Date
Relationship to Applicant
This is to certify that the information given on this form is complete and accurate to the best of my knowledge. I am fully aware that
false or misleading statements will result in an automatic denial of admission.
_____________________________________________ __________________
Applicant’s Signature
Date
San Juan College Academic Degrees Available to International Students
Programs of Study

Biology (AS.BIOL)

Business Administration (AA.BADM)

Chemistry (AS.CHEM)

Computer Science (AS.COSC)

Early Childhood Education (AA.ECED)

Engineering (AS.ENGR)

General Education (AA.GEN) (for undecided degree-seeking)

General Science (AS.GSCI)

Geology (AS.GEOL)

Geography (AS.GEOG)

Human Services – Criminal Justice
(AA.HMSV.CRJS)

Human Services – Generalist Studies
(AA.HMSV.GETR)










Human Services – Substance Abuse
(AA.HMSV.SAST)
Liberal Arts (AA.LBAS)
Mathematics (AS.MATH)
Native Studies (AA.NATV)
Outdoor Leadership and Recreation (AA.OLER)
Physical Education (AA.PHED)
Physics (AS.PHYS)
Pre-Medical Science (AS.PMED)
Psychology (AA.PSYC)
Teacher Education (Elementary – AA.EDUC.ELEM, Secondary –
AA.EDUC.SEC or Special Ed – AA.EDUC.SPED)
Associate of General Studies (non-transferable degree) +
*Programs with an asterisk require a separate application in addition to the San Juan College application and have specific deadlines for
Fall, Spring and Summer admission. Contact the program directly for information regarding program details and application deadlines.
+Must meet with the Director of Advising & Counseling.
Application & Credential Deadlines
For priority consideration, apply by the following dates:
Students planning to begin in the Fall semester
February 15
Students planning to being in the Spring semester
August 15
Students planning to being in the Summer semester
December 15
Updated 2/7/2014