Statement of Financial Responsibility - DOC by NbX8aK7u

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									                              Statement of Financial Responsibility
Purpose: In accordance with Federal law, you must provide documentation that funds exist
for your first year of study. Additionally, adequate funding must be available from the same
or equally dependable sources for subsequent years of study.

Please complete the following:

I _____________________________________ (your name) affirm that:

I will have sufficient funds to pay all of my estimated expenses for the first year of enrollment in the amount
of $___________(cost varies on program). The specific source of my funds and the amount in U.S. dollars to
be received are listed below.

  Personal Funding Ability (funds from student) loan,
    Source 2: Type of Assistance (ie                    gift, salary, etc.): ____________
    Amount Available before beginning first year of study:
      Name: _____________________________________________________________________
    $_______________________________
      Relationship to you (parent, employer, agency, etc.): _________________________________
       Source 1: Type of Assistance (ie loan, gift, salary, etc.): ____________
       Amount Available before beginning first year of study: $_______________________________
       Source 2: Type of Assistance (ie loan, gift, salary, etc.): ____________
       Amount Available before beginning first year of study: $_______________________________
       Source 3: Type of Assistance (ie loan, gift, salary, etc.): ____________
       Amount Available before beginning first year of study: $_______________________________


       Will the above sources be available in future years? Yes                 No
                      What dollar amount will be available to you from this source in future years?
                      $__________ per annum
       Describe the documents you are providing as evidence of this source (required): ___________
       ___________________________________________________________________________


  Funding Source #1

       Name: _____________________________________________________________________
       Relationship to you (parent, employer, agency, etc.): _________________________________
       Address:____________________________________________________________________
       ___________________________________________________________________________
       Type of Assistance (ie loan, gift, salary, etc.): _______________________________________
       Amount Available before beginning first year of study: $_______________________________
       Will this source be available in future years? Yes               No
                      What dollar amount will be available to you from this source in future years?
                      $__________ per annum
       Describe the documents you are providing as evidence of this source (required): ___________
       ___________________________________________________________________________
  Funding Source #2

      Name: _____________________________________________________________________
      Relationship to you (parent, employer, agency, etc.): _________________________________
      Address:____________________________________________________________________
      ___________________________________________________________________________
      Type of Assistance (ie loan, gift, salary, etc.): _______________________________________
      Amount Available before beginning first year of study: $_______________________________
      Will this source be available in future years? Yes            No
                      What dollar amount will be available to you from this source in future years?
                      $__________ per annum
      Describe the documents you are providing as evidence of this source (required): ___________
      ___________________________________________________________________________



    (1) I am attaching official documentation to verify the availability of each source of my funds
         as indicated above.

 Supplemental Information Needed:


    Foreign Address (required)
    Address Line 1 _____________________________________________________________
    Address Line 2 _____________________________________________________________
    City ______________________________________________________________________
    State/Providence ___________________________________________________________
    Country __________________________________________________________________
    Postal Code (zip code)_______________________________________________________

           □    Check here for your I-20 to be sent to this address

    US Address (optional, you can update this upon arrival if you do not have a present US address)
    Address Line 1 ____________________________________________________________
    City _____________________________________________________________________
    State ____________________________________________________________________
    Postal Code (zip code) ______________________________________________________

           □          Check here for your I-20 to be sent to this address

Country of Birth__________________________________________________


Country of Citizenship_____________________________________________


I hereby certify that the information I have provided is accurate and complete to the best of my knowledge. I
will have the above listed funding available to me during my first year of school, and this funding is expected
to continue at the same level throughout my education at Rosalind Franklin University of Medicine and
Science.
________________________________________________                          _________________________
Signature                                                                 Date

________________________________________________                          _________________________
Printed Name                                                              Academic Program in which I am an Applicant

								
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