Download Financial Resources Statement - Providence Christian College

Office of Admissions
International Application
FINANCIAL RESOURCES STATEMENT
(For International Students only)
Name: ____________________________________________________________________________________
Family
First/Given
Middle
SECTION A - FAMILY INFORMATION (DEPENDENT STUDENT)
If you are dependent upon your parents or other family member(s) for daily living expenses, fill in this section
completely. (If you do not depend on someone else, skip this section and go to Section B.)
Father’s Name: ______________________________________ Occupation: ___________________________
Mother’s Name: ______________________________________ Occupation: ___________________________
Give the following information for those that are dependent on you parents:
Name
Age
Relationship
________________________________________
________
_______________________
________________________________________
________
_______________________
________________________________________
________
_______________________
________________________________________
________
_______________________
________________________________________
________
_______________________
SECTION B – FAMILY INFORMATION (INDEPENDENT STUDENT)
If you are not dependent upon your parents, or are married and have your own family to support, fill in this
section completely.
Give the following information for each person who is financially dependent on you:
Name
Age
Relationship
________________________________________
________
_______________________
________________________________________
________
_______________________
________________________________________
________
_______________________
________________________________________
________
_______________________
________________________________________
________
_______________________
Which of those listed will come with you to the U.S.?
__________________________________________________________________________________________
__________________________________________________________________________________________
Of those who remain at home, who will continue to dependent upon you while you are in the U.S.?
__________________________________________________________________________________________
__________________________________________________________________________________________
How will their expenses be covered?
__________________________________________________________________________________________
Will you need to provide money to them while you are in the U.S.? ____________________________________
How much?
US$ __________________ per month
US$ ___________________ per year
SECTION C – FINANCIAL INFORMATION
Give present value of family assets (your parents if you are dependent, yours if you are independent)
Home………………. US$ __________________
Savings …………. US$ _________________
Land/Buildings…….. US$ __________________
Investments …….. US$ _________________
Checking Account … US$ __________________
Other …………… US$ _________________
Sources of income:
2006
Estimated 2007
Yourself ………………………. US$ _________________________
US$ __________________________
Parents …………………………US$ _________________________
US$ __________________________
Spouse (if married) …………… US$ _________________________
US$ __________________________
Other …………………………. US$ _________________________
US$ __________________________
Do you have a source for emergency funds once you arrive in the U.S.? Explain.
__________________________________________________________________________________________
__________________________________________________________________________________________
How will you pay for transportation to the U.S.?
__________________________________________________________________________________________
SECTION D – SPONSOR/SUPPORT INFORMATION
List agencies/foundations/government to which you are or will be applying for aid/sponsorship:
Source
Date Decision Expected
___________________________________________________________
________________________
___________________________________________________________
________________________
___________________________________________________________
________________________
___________________________________________________________
________________________
Source Amounts:
Family………………. US$ __________________
Student Savings …………. US$ _________________
Relatives ……...…….. US$ __________________
Government ……… …….. US$ _________________
Friends …………... … US$ __________________
Agencies …… …………… US$ _________________
I/We declare that the information on this form is true, correct, and complete. Providence Christian College has
my/our permission to verify the information reported.
___________________________________________________________
________________________
Signature of Student
Date
___________________________________________________________
________________________
Signature of parent, sponsor, or guardian (if dependent student)
Date
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SPONSORSHIP
Name: ____________________________________________________________________________________
Family
First/Given
Middle
It is the student’s responsibility to be sure that all funds are sent in a timely manner so bills are paid by the
required due date.
DOCUMENTATION FOR SAVINGS/INVESTMENTS: An official signed statement or letter from the bank
confirming the value of your/your parent’s savings (convert all amounts to U.S. dollars)
DOCUMENTATION FOR SPONSOR(S): A current signed and notarized letter from each sponsor stating
intent to cover expenses with an exact U.S. dollar amount
STUDENT’S AND/OR PARENTS’ SAVINGS/INVESTMENTS AVAILABLE FOR EDUCATION
Name & Address of Bank(s):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
PERSONAL SPONSOR (RELATIVE, FRIEND, OR EMPLOYER)
Name of Sponsor: ________________________________Relationship: ______________Amount: US$ ______
Name of Sponsor: ________________________________Relationship: ______________Amount: US$ ______
AGENCY SPONSOR (GOVERNMENT, ORGANIZATION)
Name of Agency Sponsor: ______________________________________________
Contact Person: __________________________________________
Amount: US$ ______
E-mail: ________________________
Address of Agency Sponsor: __________________________________________________________________
ADDITIONAL SPONSORS
1. Name of sponsor: ___________________________________________________
Amount: US$ ______
Address: __________________________________________________________ E-mail: _________________
2. Name of sponsor: ___________________________________________________
Amount: US$ ______
Address: __________________________________________________________ E-mail: _________________
3. Name of sponsor: ___________________________________________________
Amount: US$ ______
Address: __________________________________________________________ E-mail: _________________
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