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School of Nursing
Office of Academic Programs
2 Koret Way, #N-331B
UCSF Box 0604
San Francisco, CA 94143-0604

Telephone: (415) 476-2595
Fax: 415-476-9707

Special Studies:
Confidential Financial Statement
For International Applicants

To study abroad, you must prove that you have the financial means to do so, and document your ability to support yourself while studying at the School of Nursing, University of California, San Francisco.

The source of these funds, whether from personal resources or from public or private sponsorship, is to be indicated and certification that you will receive them while at the University. In some cases, you may be required to deposit funds at a local bank before you are permitted to register.

In calculating the amount of money you will need, you should take into account travel expenses both to and from the United States, all fees and educational expenses for the time you intend to study, and housing and living expenses while you are here. Unfortunately, financial assistance or part-time employment is not available through the University, nor can it assume any financial responsibility. You should think very carefully, therefore, about the expense of studying in the United States.

Your government may limit the amount of money that can be sent abroad, and you should make certain that sufficient funds are available before you leave. It also may require a verification of enrollment, which you can request from the Office of Academic Programs after registration is completed.

The Confidential Financial Statement is to be returned to the Office of Academic Programs as part of your application. A Certificate of Eligibility (Form IAP-66) then will be requested and sent to you so that an exchange visitor visa (J-1) can be granted by the United States consul in your country.

See http://nurseweb.ucsf.edu/www/ps-i.htm for more information on Special Studies programs at UCSF School of Nursing.

Sections A and E (below) are required.

Section A: General Information
Name
Address
Date of Birth		Place of Birth
If you will be accompanied by your spouse or your children, please indicate:
Name	Relationship	Birthdate	Birthplace
Name	Relationship	Birthdate	Birthplace
Name	Relationship	Birthdate	Birthplace
If your government limits the amount of money that can be taken out of the country, please explain.
How much money in U.S. dollars (US$) will you have upon arrival at the University of California, San Francisco?
How much money will you be receiving?
How often will you receive these funds? [ ] Monthly [ ] Quarterly [ ] Yearly

Complete only the section B, C, or D as appropriate for your source(s) of funds.

Section B: Personal Savings

Total amount of personal savings available for study (US $):

Bank Certification:
"This is to certify that the savings information furnished by the applicant is true and accurate."

Name of bank official

Signature of bank official

Date

Title

Bank

Address

(Affix official seal if appropriate.)

Section C: Sponsor (Government, Foundation, University)

Name of sponsor
(Award Letter must be attached)

Address

Number of years

Amount awarded annually

Name of certifying official

Signature of certifying official

Date

Title

Section D: Sponsor (Private)

Sponsor Certification:
"This is to certify that I guarantee to provide US $ ___________ per month for _________ months to
support the applicant's study at the University of California, San Francisco."

Name of sponsor

Signature of sponsor

Date

Relationship

Address

Bank Certification:
"This is to certify that, to the best of my knowledge, the sponsor named above is
financially capable of meeting the stated commitment."

Name of bank official

Signature of bank official

Date

Title

Address

Section E (below) is required.

Section E: Applicant Certification
"This is to certify that the information furnished on this form is true and complete to the best of my knowledge. I further understand that cancellation of my admission privileges may result if any information is found to be incomplete or inaccurate."
Signature of Applicant	Date

OAP/FIN (9/2000, 8/2006)

Special Studies: Confidential Financial Statement For International Applicants

Special Studies:
Confidential Financial Statement
For International Applicants