| Please enter the following information: |
| Email Address: |
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| LAST Name: |
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| FIRST Name: |
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| MIDDLE Name or Initial: |
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| Student Number: |
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| Street: |
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| City: |
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| State: |
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| Zip: |
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I certify that I have liquid assets totaling an amount equal to or greater
than $21,474 * (U.S. Dollars) and this money is to be used exclusively for educational and associated living expenses during my enrollment at Jacksonville State University. |
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| A. Student's Personal Funds: |
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List names/addresses of financial institutions where funds are deposited. List names on accounts and account numbers:
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| B. Funds From Other Sources: |
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List those specific funds identifying the source and the names/addresses of financial institutions where funds are deposited. List names on accounts and account numbers:
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I swear (affirm) that this information is true and correct. I authorize Jacksonville State University to release any information to Immigration and Naturalization Service and other agencies as necessary. Additionally, I authorize Jacksonville State Univeristy verification rights to above referenced bank accounts and supplementary information.
* This amount must equal or exceed the amount on the I-20 ($21,474 for 2010-2011 year plus $2500 for each dependent added). |
