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APPLICATION FOR VISA DOCUMENT (For International Students Only)

Instructions: Print document before attempting to complete it.  Please read entire form before answering questions.

This form will help us determine if you meet the financial requirements necessary for making a formal application to the Pennsylvania State University. You should not expect to receive financial assistance from Penn State University unless you have been informed in writing that you have been awarded an assistantship or scholarship. Submit this application with your financial gurantee to your graduate department of interest or the Undergraduate Admissions Office.  Before we can issue a visa document, the law requires us to be assured that you will have enough money to meet educational and personal expenses for each year that you plan to study in the United States.

NAME IN FULL as it appears on passport:

Mr.__ Ms.__ Family Name (Surname)__________________________

First Name_________________________  Middle Name________________________

COUNTRY OF BIRTH: ___________________ COUNTRY OF  CITIZENSHIP : ____________________
 

Most recent OCCUPATION IN HOME COUNTRY: If student, state educational

level_______________________________________________________
 

DATE OF BIRTH (month/day/year):______________________
 
Campus which you would like to attend:___________________________________________

 

Check one category each in sections A,B,C, and D:

A. Program for which I have applied at Penn State:

___Undergraduate in __________________

___Master's in __________________

___Ph.D. in ___________________

___Other ___________________

B. I will come to Penn State from outside the U.S. _____ from within the U.S. _____ (If currently a U.S. student, attach copies of the following: your visa, I-94, and I-20 or IAP-66; plus visa and I-94 of any dependents. If you are a dependent, include copy of principal's visa and I-94.

C. Document to be issued by Penn State:

___I-20 (for F-1 student visa) My primary source of funding is a Penn State assistantship, scholarship, personal, or from family or friend. (F-1 dependents will be issued F-2 visas.)

___IAP-66 (for J-1 Exchange Visitor/Student visa) My primary source of funding is U.S. or home-country government or an international organization. (J-1 dependents will be issued J-2 visas.)

___I DO NOT NEED A PENN STATE DOCUMENT BECAUSE: ____ My sponsoring agency will issue it. ____ I will remain on my ________ visa (attach photocopies of your visa and I-94. If you are now F or J, you must request a new document from Penn State. ____ I am a permanent resident (attach copy of green card).

D. MARITAL AND DEPENDENT STATUS If you do not provide financial support for dependents (spouse and/or children under 21) at time of admission, you must wait six months to apply for them to join you in the U.S..

___I am not married___I am married but plan to come alone___I am married, and my spouse is a Penn State student___I am married, and the following dependents will come with me (or are already in the U.S.):

ATTACH sheet with dependents' family name, given name, relationship, birthdate, birthplace, and country of citizenship, if they will accompany you.

FINANCIAL CERTIFICATION

If you will be ACCOMPANIED BY DEPENDENTS (spouse and/or children), you will be fully responsible for their support, and additional funds are required. University assistantship stipends are not sufficient to cover dependents' expenses and are not intended to do so. The annual current requirement, including the fee for mandatory medical insurance (estimated cost shown in parentheses), is: SPOUSE, $5,858 ($2,263); EACH CHILD, $3,207 ($1,074). If you bring your family, please be prepared to incur those expenses.

E. SOURCES OF FINANCIAL SUPPORT (first year of study) Total expenses are estimated to be $22,917 for graduate students ($25,887 for students in graduate programs requiring 12 credits or more per semester); $23,864 for undergraduate students.

$ __________ Own funds:(Attach an official bank statement, in your name, dated within the last six months, that includes current account balance and equivalent in US dollars or current exchange rate.)

Name of bank
________________________________________________________________________________________

Address
________________________________________________________________________________________ ________________________________________________________________________________________

$ __________ Family or other personal support: (If guarantor is not a US citizen or permanent resident, attach notarized affidavit indicating the amount of guaranteed support and a bank statement indicating amount available to you. If guarantor is a US citizen or permanent resident, an I-134 Affidavit of Support (obtainable from US consulate or this office) or an equivalent form should be completed and sent to this office with current bank statement and confirmation of employment.) All documents must be dated within the last six months.

Name of sponsor ____________________________ Relationship to you ____________________

Address ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

$ _________** Stipend from Penn State graduate assistantship or fellowship (Include copy of assistantship offer. Tuition will be added by ISS.)

Department ______________________________________________________________________________

**If your stipend is less than $11,356, (estimated living expenses, Fall and Spring books, and 20% of medical insurance), you must provide evidence of additional financial resources to equal the difference of the stipend. If you will not be able to attend Penn State without University support (assistantship, fellowship, etc.) complete and return this form with a copy of the award offer to your department after you have been notified.

$ _________ Government or other sponsoring agency (The IAP-66 will be issued only for the time period specified by your sponsor. Attach a signed copy of the award letter; it must state number of years and specific amounts given each year.):

Name of agency
____________________________________________________________________________________

Address
____________________________________________________________________________________              ____________________________________________________________________________________ ____________________________________________________________________________________

F. ANTICIPATED SOURCE AND AMOUNT OF SUPPORT FOR THE SUBSEQUENT YEARS OF STUDY:

Name of Supporter(s):      ________________________________________________________________________________________ ________________________________________________________________________________________

I certify that all information provided on this form is correct and complete. I shall notify the Office of International Students of any change in financial circumstances, or accompanying dependents, or of plans not to attend Penn State. I will return the visa document, if issued, if I postpone my admission to a later semester or do not attend Penn State.

Signature ________________________________ Date _________________________________

G. Address you would like visa document                      After that date, mail document to:
     mailed to until __________ (date):
___________________________________                  __________________________________
___________________________________                  __________________________________
___________________________________                  __________________________________
___________________________________                  __________________________________
 

FAX Number (if available): ___________________  E-Mail Address (if available): ________________

Phone Number: