Section A - Manhattanville College

2015/2016 Undergraduate J1Visiting Scholar or Student
Certification of Finances
Name (family/surname, first/given) as written on passport Mailing Address Email Address Date of Birth (month/day/year) Phone Number Country of Citizenship All international visiting students who apply for admission to Manhattanville College must also submit this Certification of Finances. This Certification outlines the financial resources that will be used to cover expense for your room and board only at Manhattanville. Strict government regulations require that the College verifies the financial resources of all international visiting student applicants before the DS 2019 Certificate of Eligibility forms can be issued. The DS 2019 will be used to apply for the J1 visa. The DS 2019 will be issued by the College upon admission. Please print your responses to each question completely and accurately. Enter all amounts in U.S. dollars. Return this Certification to the Office of Undergraduate Admissions by express/courier mail or by FAX 1.914.694.1732. Complete Sections A through E as appropriate. Cost of Attendance at Manhattanville The estimated 2015/2016 undergraduate
Student expense budget includes Tuition & fees $36,220
Room & Board 14,520
Books & Supplies 2,910
Insurance 1,650
J1 SEVIS Fee (one time payment) 180
Total $
$19,080* If coming only one semester document $9,540 Annual Estimated Cost of Manhattanville in U.S. Dollars (does not include transportation)
Section A Enter the amount of annual support you will receive to finance your educational costs for EACH year of your undergraduate program. Support may come from one or a combination of the sources listed below (amounts be listed in $U.S.)
1. Student’s and/or parents savings/investments available for education. 2015/16 $19,080 2016/17 projected 2017/18 projected 2018/19 projected N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 2.
Name of Bank(s)__________________________________________________ _______________________________________________________________ Please attach a signed statement or letter from the bank confirming the values of your/your parents’ savings and complete Section B Parents’ income/salary available for education (typically not to exceed 25% of total income) 3.
Please attach an income statement, tax form or a signed letter from parents’ employer confirming the value of income/salary (convert to $U.S.) Money available from other sponsors, private organization and /or government. Please attach a signed letter from the sponsor, private organization and/or government confirming the value of the award (convert to $U.S.) and complete Section C 4. TOTAL (if you are coming for only one semester, document $9,540) Section B To be completed by the bank official if some or all of your funds will come from your or your parents’ savings/investments. I certify that I have read the saving/investment information in Section A.1 and that the funds are available as indicated. Name of Bank Name and Title of Bank Official Address of Bank Signature and Date Section C To be completed by sponsor, private organization and/or government, if some or all of your funds will come from these sources. I certify that I have read the sponsor, private organization and/or government information in Section A.3 and that the funds will be provided. Name of sponsor, private organization and/or government Name and Title Address Signature and Date Section D Does your government impose restriction on exchanges and release of funds for study in the U.S.? Yes  No  If yes, please explain ___________________________________________________________ Do you have funds, beyond those listed in Section A, to be used for travel to and from the U.S. and for emergencies? Yes  No  If yes, list amount in U.S. dollars $ __________________________ (Students should be prepared to finance their travel expenses.) HEALTH INSURANCE – All Manhattanville J1 students are required to have adequate health insurance coverage. Students will automatically be enrolled in our insurance. However, if they are interested in waiving this coverage the waiver period ends in early September. https://consolidatedhealthplan.com/group/78/waiver/1 Do you plan to remain in the U.S. during the summer? Yes  No  Do you plan to attend Summer School? Yes  No  (Student who plans on remaining in the U.S. during the summer should be prepared to finance these additional expenses.) Section E We certify that the information on this form is true and complete. The funds are available and will be provided to support the cost of a Manhattanville education. We understand that any misrepresentation may be cause for refusing or revoking admission. We understand our obligation to meet, on an annual basis, the family responsibility as outlined above as a condition for continued enrollment at Manhattanville College and to satisfy the U.S. Citizenship and Immigration Service’s regulation required to maintain an officially authorized U.S. student visa status. Both the student and the parent must sign below. Student signature: Parent signature Date Date RETURN TO: Office of Admission, Manhattanville College, 2900 Purchase Street, Purchase, NY USA 10577 Phone: 914.323.5111 Fax: 914‐694‐1732 Email: intladmissions@mville.edu