Confidential Financial Statement
Confidential Financial Statement
Confidential Financial Statement
This form must be completed and signed to verify evidence of financial support for the issuance of a UCLA I-20 or DS-2019.
Signatures, bank statement(s) dated within the last 6 months, and/or supporting verification documents are required.
Applicant Information
Spouse - $4,500
First Name
Middle Name
_____________________________________________________________
|
U.S. $ _______________
Personal Funds
Amount of personal funds as
stated on your bank statement.
Day
Year
Sponsors Guarantee
U.S. $ _______________
_____________________________________________________________
Family/Last Name
|
First Name
Middle Name
Day
Year
U.S. $ ________________
Family/Last Name
|
First Name
Middle Name
U.S. $ ________________
[*Must submit copy of the award letter issued from sponsoring entity
specifying the amount and duration of funds.]
Month
Day
Year
U.S.$ ____________
Signature of Applicant: I hereby confirm the information indicated in this statement is true to the best of my knowledge and that I will have
the funds stated to attend UCLA. I understand that my enrollment at UCLA may be jeopardized if any information indicated here is found to be
incomplete or false. I will notify UCLA immediately if there are any changes in my financial situation.
Signature of Applicant __________________________________________________________________ Date ________________________________
UCLADashewCenterforInternationalStudents&Scholars(DCISS) 106BradleyInternationalHall 417CharlesE.YoungDriveWest,LosAngeles,CA,9009513793108251681 internationalcenetr.ucla.edu