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UCSC Office of International Education Intern

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					Student Name:____________________________                     UCSC Student ID: _______________________________

                             CONFIDENTIAL FINANCIAL CERTIFICATE FOR 2011-2012
                For International Undergraduate Students Requesting a Certificate of Eligibility (I-20/DS-2019)
                                            University of California, Santa Cruz

THE PURPOSE OF THIS FORM
Every applicant eligible for a nonimmigrant student visa (F-1 or J-1) must complete and submit this form before a Certificate of
Eligibility can be prepared by the University of California, Santa Cruz(UCSC). A Certificate of Eligibility is also known as an I-20
(for F-1 students) or DS-2019 (for J-1 students). This is the document you will need to apply for an F-1 or J-1 student visa at a U.S
Consulate or Embassy. For more visa information please visit the International Scholar and Student Services (ISSS) web site at
http://oie.ucsc.edu/is3/students/prospective.html

You are required to certify that you will have sufficient funding available for your minimum living and educational expenses at UC
Santa Cruz. If you will bring dependents (spouse/child) on F-2 visa(s) for the academic year, you must be able to show additional
funds to cover their living expenses as well. Please complete this form and certify that you have adequate funds to meet at least the
minimum amount. PLEASE NOTE THAT AMOUNTS FOR FEES AND LIVING EXPENSES ARE SUBJECT TO CHANGE AND
THAT INDIVIDUAL NEEDS MAY VARY FROM THE MINIMUM AMOUNTS STATED.

F-1 or J-1 international students do not qualify for in-state tuition. You must not expect any federal financial aid from the
University unless you are a student with official verification of such an award. Do not plan on employment to meet your financial
needs. The U.S. Consulate/Embassy and the U.S. Department of Homeland Security (DHS) also require proof of funding before
issuing a visa or admitting you to the U.S.

F-1 Versus J-1
F-1 is the most common status used by international students in the U.S. Most degree-seeking international students at UCSC have the
F-1 status.
J-1 is generally used for students in specific educational exchange programs such as the UC Education Abroad Program, or Fulbright,
however, it may also be used by degree-seeking students. If you believe that you should/must obtain J-1 status, please contact the
International Student Adviser at UCSC to discuss your situation: Fvisa@ucsc.edu

SEVIS
The Student and Exchange Visitor Information System (SEVIS) is a web-based database developed by the U.S. Department of
Homeland Security to electronically track and monitor the activities of international students and exchange visitors on F, J, and M
visas. Educational institutions that issue visa documents for international students and exchange visitors are required to report
through SEVIS certain personal and enrollment information. Therefore, it is very important that the information that you enter below
is accurate. If there are changes after you submit this form, please inform Admissions Office at myapplication@ucsc.edu so your
record can be updated in a timely manner.



CERTIFICATION BY APPLICANT: This is to certify that all information furnished on this form is true and complete to the
best of my knowledge. I fully understand the minimum amount necessary for my stay in the U.S, and that of my dependents if
applicable. I also understand that university fees are subject to change and that my individual financial needs may vary from the
minimum amount stated on this form.

I agree to inform myself of and obey the U.S. Department of State (DOS) and the U.S. Department of Homeland Security (DHS)
requirements for international students; to be a full-time student in the educational program and school that the DHS authorizes me to
attend as noted on my Certificate of Eligibility (I-20 Form/DS-2019 Form); to follow the DHS required procedures before
transferring schools or extending my educational program; to obtain the recommendation of the International Student Adviser at the
UCSC International Scholar and Student Services Office and/or U.S Citizenship and Immigration Services authorization before
working in the U.S. I agree to learn the requirements of my international student status and to read my I-20/DS-2019. I will attend
the UCSC International Scholar and Student Services Office MANDATORY International Student Orientation.

Signature: ________________________________________________                       Date___________________________


NEW UNDERGRADUATE STUDENTS: SUBMIT THIS FORM AND THE REQUIRED DOCUMENTS TO UCSC ADMISSIONS OFFICE
Jill Sakamoto, Assistant Director of Admissions, Office of Admissions
University of California, Santa Cruz,
1156 High Street, Santa Cruz, CA 95064
Phone: 831-459-2131 Email: myapplication@ucsc.edu Web: http://admissions.ucsc.edu/



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Student Name:____________________________                   UCSC Student ID: _______________________________
Student Information: Please Attach A Copy Of Your Passport ID Page

Biographical Information: Enter information exactly as it appears on your passport
Surname (Last/Family Name):                                        Given Name (First Name):
Date of Birth (Month/Date/Year):                                   Gender:  Female  Male
Country of Citizenship:                                            Country of Legal Permanent Residence:
Country of Birth:                                                  City of Birth:

Address Information:
Foreign Address
Street (Please include Apartment No. if applicable):
City:                                                              State/Province:
Postal Code:                                                       Country:
Email:                                                             Telephone:


Mailing Address (This is the address to which we will send your visa documents)      Please use my foreign address
Street (Please include Apartment No. if applicable):
City:                                                               State/Province:
Postal Code:                                                        Country:
Email:                                                              Telephone:


UCSC Information:
Student ID Number (If known):
Admit Term:  Summer 2011 Fall 2011  Winter 2012  Other (Please specify):


Immigration Status:
Which Status Do You Plan To Hold At UCSC?  F-1  J-1
Are You Currently In The U.S?  Yes  No
If Yes, What Is Your Current Status?  F-1  J-1  Other (Please Specify):
If You Are Currently On F-1 or J-1, Do You Plan To Transfer From Another U.S School To UCSC?  Yes  No  Not Applicable
If Yes you must also complete the Undergraduate Transfer Verification Form available at http://oie.ucsc.edu/is3/students/forms.html
If You Are On A Different Visa Status, Do You Plan to Change Status to F-1 or J-1 Within The U.S?  Yes  No  Not Applicable
If Yes please consult an International Student Adviser at Fvisa@ucsc.edu.


Dependent Information: Please Attach A Copy of Each Dependent’s Passport ID Page

Will any dependents (legal spouse or child) accompany you?  YES  NO
If Yes, complete the following section (If more room is needed please attach additional sheets)
Note: spouses and children of F-1 student visa holders may not work in the United States under any circumstances.
Enter information exactly as it appears on the passport
Surname (Last/Family Name):                                        Surname (Last/Family Name):
Given Name (First Name):                                           Given Name (First Name):
Date of Birth (Month/Day/Year):                                    Date of Birth (Month/Day/Year):
Relationship:  Spouse  Child                                     Relationship:  Spouse  Child
Gender:  Male  Female                                            Gender:  Male  Female
Country of Citizenship:                                            Country of Citizenship:
Country of Residence:                                              Country of Residence:
City & Country of Birth:                                           City & Country of Birth:




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Student Name:____________________________                    UCSC Student ID: _______________________________
Financial Information: Please Attach Documents of All Proof of Funds
Please use the table below to calculate the minimum fees and expenses required for Academic year 2011-12. A detailed breakdown of
fees can be found in Document “International Student Financial Estimate” at http://oie.ucsc.edu/is3/students/forms.html.

F-1 students must guarantee fees and living expenses for the first academic year for the issuance of I-20
J-1 students must guarantee fees and expenses for the duration of the DS-2019


Required Fees & Expenses 2011-12                                    Undergraduate Student
Tuition & Fees (Including Campus Health Insurance)                  $36,876
Living Expenses                                                     $18,045
Dependent Expenses-Add                                              +$
$9,000 Spouse
$4,500 per Child
Total Annual Budget                                                 =$
J-1 students ONLY must multiply their Total Annual Budget by         ____ years
the number of years requested on the DS-2019                        =$


Indicate here the sources and amount of support you will have for yourself & dependent(s) if applicable, and attach required
documents.

ALL DOCUMENTS MUST BE DATED WITHIN THE PAST 6 MONTHS. PLEASE ALSO INCLUDE A CERTIFIED COPY OF THE
TRANSLATION IF THE ORIGINALS ARE IN A LANGUAGE OTHER THAN ENGLISH.

Source                                        $ Amount                          Required Documents
 Personal Funds                                                                Bank statement(s), bank letter (s), or completed Bank
                                                                                Certification By Bank Official (Please see page 4)
 UCSC                                                                          Letter(s) from UCSC on official school letterhead
                                                                                stationery


 Parent(s)/Family/Individual Sponsor                                           Letter(s) stating intention to provide support including
                                                                                the amount and duration (Please see template on page
                                                                                4), AND bank statement(s), bank letter(s) from
                                                                                sponsor’s account, or completed Bank Certification By
                                                                                Bank Official (Please see page 4)


 Sponsoring Organization, Employer,                                            Award letter(s) or other verification of type, duration,
Government, etc.                                                                and amount of support



 Other Support                                                                 Statements, letters or other types of verification

Your Total:                                   $




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Student Name:____________________________                      UCSC Student ID: _______________________________

CERTIFICATION BY BANK OFFICIAL (For Personal Funds)
This is to certify that the current balance of ______________________ (student name)'s account(s) with this bank is

________________(amount in U.S dollars).

                                                                                   OFFICIAL BANK STAMP HERE PLEASE:
Signature of Bank Official___________________________ Date___________

Print name in English______________________________________________

Name of Bank____________________________________________________

Address_________________________________________________________



If there is more than one bank, please attach to this form other statements, signatures and certifications.


***************************************************************************************************


CERTIFICATION BY BANK OFFICIAL (For funds from Parents/Family/Individual Sponsor)

This is to certify that the current balance of ____________________ (sponsor name)'s account(s) with this bank is

________________ (amount in U.S dollars).

                                                                                   OFFICIAL BANK STAMP HERE PLEASE:
Signature of Bank Official___________________________ Date___________

Print name in English______________________________________________

Name of Bank____________________________________________________

Address_________________________________________________________


Letter of Intention to Support:
(Sponsor can either complete the letter on this form, or attach a separate letter containing the following information)

I (sponsor name)________________________________, promise to provide _________________ (amount in U.S. dollars) for the

educational and living expenses of _________________________________________________________________________

(student name, and dependents’ names if applicable) at the University of California, Santa Cruz for _____ years.


Signature of Sponsor________________________________ Name in English ________________________________________

Address__________________________________________________________________________________________________

Relation to Applicant_________________________ Date_______________________


If there is more than one bank or/and sponsor, please attach to this form other statements, signatures and certifications.




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