Certification of Finances for Marywood's Intensive English Program
This form cannot be submitted electronically. It should be printed out and mailed in when completed to the address below.

Last Name:
First Name:

Permanent Address:

Mailing Address:

Date of Birth (month, day, year):

Place of Birth:

Country of Citizenship:

Applying for: Fall (Aug) Spring (Jan) Summer (July)

Expected VISA type:

Student (F-1)
Spouse or Child of Student (F-2)
Other (Specify)

The US Immigration Service requires that Marywood have signatures on file clarifying that an applicant has financial resources adequate to provide for expenses without resorting to employment in the US. Enter amounts in US dollars. Please PRINT or TYPE all entries. Use an additional sheet of paper for explanations, if necessary.

Student's Sources of Funds	Assured Support	This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
Personal or Family Savings: A bank official's signature is required on the certification if the student is partially or totally supported by personal savings. Name of Bank:	US$	Signature of bank official: _________________________ Title ____________________ Name of Bank ____________________ Address of Bank ____________________ Date __________
Parents: Money available from sources other than savings Name: Name: Explain source:	US$	Parent's signature is required. Signature of Parent: _________________________ Address _________________________ Date __________
Sponsors: Money available from sources other than parents Name: Name: Explain source:	US$	Sponsor's signature required. Signature of Guarantor: _________________________ Address _________________________ Name of Bank ____________________ Relationship to Student _________________________ Date __________
Your Government: Name:	US$	Enclose a signed copy of your letter of award.
TOTAL:

What is the current exchange rate for your country's currency to the US dollar (for example, 20 pesos = $1)?

Who will pay for your transportation to the US?

Does your government currently impose restrictions on exchange and release of funds for study in the US?

Yes No
If YES, describe restrictions:

Do you have emergency funds once you arrive in the US?

Yes No
If YES, name source:

What is the total amount of money you expect to have when you arrive at this institution?

Signature of Applicant:

I realize that I am fully responsible for my financial viability while studying in the US and will be held accountable to Marywood for maintaining the terms of this statement. I certify that I have a minimum of $________ in US currency available to me while I am studying at Marywood. I further certify that I can make the necessary arrangements to have these funds transferred to the US in the event of an emergency. I am aware that the fees for this program are payable in full before the beginning of the course and I will pay them in accordance with the application conditions. I understand that a Certificate of Eligibility (I-20) will not be authorized until this form is completed and returned to Marywood. I certify that the information on this form is true, correct and complete. I understand that any misrepresentation may be cause for refusing or revoking admission.

Signature of student _______________________________ Date __________

Signature of parent _______________________________ Date __________ (if applicant is under 18 years of age)

Return this form along with the application deposit to:

Intensive English Program
Marywood University
2300 Adams Avenue
Emmanuel Hall, Room 102
Scranton, PA 18509 U.S.A.