Virginia Tech Graduate School Financial Certification for International Students

Curriculum name: __________________________________

Degree Desired:

[ ] Master's [ ] Doctoral [ ] Non-degree [ ] Commonwealth-campus [ ] Undergraduate-dual [ ] Undergraduate-combined [ ] Professional certification (education only)

Semester studies will begin:
	[ ] Fall [ ] Spring	[ ] Summer-I [ ] Summer-II	Year: ________

Address: (all correspondence will be mailed here):

________________________ ________________________ ________________________ ________________________

Marital Status:

[ ] Single [ ] Married

Dependents
The following dependents will accompany me:

Name ________________ ________________ ________________

Place of birth ________________ ________________ ________________

Date of birth ________________ ________________ ________________

Relationship ________________ ________________ ________________

Source and Amount of Support

(Fill in amounts in US dollars in the appropriate categories. Please attach documentation as required. Statements older than six months are not acceptable.)

	Amount
Personal Funds: (Must attach bank statement)	___________
Parents and/or Sponsors: (Must attach bank statement and official letter from sponsor stating name, relationship and amount of support per year)	___________
Government Agency: (Must attach signed copy of your award)	___________
University Award: (Must attach award letter or copy of assistantship agreement)	___________
Total: (Total should meet or exceed Virginia Tech requirement for your academic status and marital status as outlined in the general instructions. If you are certifying less than required, please attach a letter of explanation.	___________

________________________________________ Applicant's signature

________________ Date