Pacific University International Application Affidavit of Support

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Pacific University
International Application
Affidavit of Support
All applicants who need a student (F-1) or Exchange Visitor (J-1) Visa to study in the U.S. must show
funds to pay for tuition, living expenses, and cost of dependents (if any) during their first year of study.
In addition to this form, you must also attach an official bank statement prepared within the last 6
months, showing the availability of these funds.
Student’s name: ___________________________________________________________
PARENT or SPONSOR SIGNS BELOW
“I certify that the information on this form is complete and correct. I understand that if I include
incomplete or false information, Pacific University may reject my application, withdraw an offer of
acceptance or cancel my enrollment at any time. I give permission for Pacific University to confirm
this information. I will notify Pacific University of any changes.
You may use more than one source of support, if necessary.
Sources of Support
Amount of Support
Additional Information
1. Student’s Personal Funds
US $ ____________________
2. Family Funds
US $ ____________________
3. Government Scholarship
US $ ____________________
_______________________________
4. Other (sponsor)
US $ ____________________
_______________________________
_______________________________
(Relationship to student)
(Relationship to student)
(Relationship to student)
l/ we agree to provide the funds shown above to the applicant for the purpose of full-time study at
Pacific University. Please attach bank documents, created in the past 6 months, showing the
availability of these funds.
Family Member (or Sponsor) Signature __________________________________Date __________________
mm/dd/yyyy
Name (Printed) ________________________________________________________________________________
Address ________________________________________________________________________________________
PLEASE PRINT, SIGN, SCAN, AND EMAIL THIS PAGE TO [email protected]
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