Graduate International Student Financial Statement
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Please enter the following information:
Email Address:
LAST Name:
FIRST Name:
MIDDLE Name or Initial:
Student Number:
Street:
City:
State:
Zip:
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.

A. Student's Personal Funds:
List names/addresses of financial institutions where funds are deposited. List names on accounts and account numbers:
B. Funds From Other Sources:
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:

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).