UNIVERSITY OF ARKANSAS SUPPLEMENTAL AND FINANCIAL

Office of Graduate and International Recruitment and Admissions

340 N. Campus Drive • Gearhart Hall 213 • 1 University of INFORMATION FORM
Arkansas Fayetteville, Arkansas 72701 USA for International Students
Tel: 1-479-575-6246 • Fax: 1-479-575-5055

If you need an F-1 or J-1 visa (or if you are in the United States and will continue your F-1 or J-1 nonimmigrant status), you are required to certify that you will have
adequate support for your program of study at the University of Arkansas. Full support for your first year must be guaranteed, and support for subsequent years must be
estimated. If you do not need to meet or maintain F-1 or J-1 status, you do not need to submit this form.

1. Name:_______________________________________________________________________________________________________________________
Last (Surname) or Family Name First Name Middle Name

2. Date of Birth: ___________________________________ Gender: Female Male Marital status: Single Married
Month Day Year

3. City of Birth: ______________________________Country of Birth: __________________________Country of Citizenship:_____________________

4. Type of Immigration form desired: I-20 for F-1 Student Visa DS-2019 for J-1 Exchange Visa None
5. Mailing address:(Note: We will use this address to mail your I-20. We send U.S. airmail unless you request express mail. See below.)

______________________________________________________________________________________________________________________________
Number and Street Town/City Province/State Country Postal Code

For express mailing: The University of Arkansas uses the services of eShipGlobal for express mailing of your admission packet containing your immigra-
tion document (I-20 or DS-2019). This express mail service will allow you to receive your documents through the carrier of your choice, typically within
3-5 days. When your I-20 or DS-2019 is issued, you will receive emailed instructions on how to select your shipping service and pay the mailing fee.

6. If you are currently in the U.S., indicate your status:_______. If your status is F-1, F-2, J-1, or J-2, what is your SEVIS ID number (begins with the letter
‘N’ followed by 10 digits)? ____________________. If you are in F or J status in the U.S. you must attach a copy of your most recent I-20 or DS-2019.

7. Dependents: Do you have any dependents who will come with you to the U.S.? Yes No
If yes, list full information below for each dependent. You must show sufficient funds to cover your dependents’ expenses while in the U.S. Please see our estimated
expenses cost sheet at http://iao.uark.edu for additional amounts needed. Please enclose a copy of the name page of each dependent’s passport, PLUS: for
children, you must also provide a birth certificate (or certificate of adoption or legal guardianship) and for a spouse, you must provide a marriage certificate.

Dependent information for SPOUSE:

_________________________________________________Date of Birth: _______________Place of birth________________________Gender F M

Surname First Middle Month/Day/Year City, Country

Dependent information for CHILDREN (if additional space is needed, please use other side of form or attach additional sheet of paper):

Name Date of Birth Place of birth

_______________________________________________ _________________________ ______________________________Gender F M
Surname First Middle Month/Day/Year City, Country
_______________________________________________ _________________________ ______________________________Gender F M
Surname First Middle Month/Day/Year City, Country
_______________________________________________ _________________________ ______________________________Gender F M
Surname First Middle Month/Day/Year City, Country

8. Please let us know how you plan to fund your studies. Indicate the approximate amount in U.S. dollars available from each source below (If
funding will come from more than one source, please check all that apply):

a. FROM PERSONAL FUNDS ..........................................................................................................................................................................$ _______________

b. FROM FAMILY OR FRIENDS.....................................................................................................................................................................$ _______________

c. SALARY WHILE ON LEAVE OF ABSENCE FROM JOB...................................................................................................................$ _______________

d. SPONSORSHIP (GOVERNMENT AGENCY, PRIVATE FOUNDATION, OR OTHER ORGANIZATION).............................................$ _______________

Name of sponsoring organization: ________________________________________________________________________
e. ESTIMATED SUPPORT FROM THE UNIVERSITY OF ARKANSAS (CHECK BOX BELOW) .........................................................$ _______________
• Scholarship (must apply separately for undergraduate scholarships at http://scholarships.uark.edu/)
• Athletic Scholarship
• Graduate Assistantship (must directly contact department). Please note that assistantships may not cover all estimated
costs. If you have additional funding available to you, please indicate by checking another source above.

TOTAL ANTICIPATED SUPPORT FROM ALL SOURCES: ................................................................................................................................. $ _______________

For issuance of an I-20 or DS-2019, total funding must meet or exceed estimated costs. See http://international-admissions.uark.edu/undergraduate-studies/
funding-your-studies.php for undergraduates and http://international-admissions.uark.edu/graduate-studies/funding-studies.php for graduate students.

Revised 11/17
https://international-admissions.uark.edu/_resources/forms/financial-statement.pdf
9. Person(s) to whom confidential information and/or documents may be released:____________________________________________________________

Information will not be released to persons not listed without your written permission.

10. If you have been in correspondence with anyone at the University of Arkansas (other than International Admissions), please list such persons and/or

offices: ____________________________________________________________________________________________________________________

11. Name, address, and email address of your hometown newspaper:______________________________________________________________________

12. How long do you plan to study at the University of Arkansas? ________________________________________________________________________

13. How do you plan to meet your expenses for the second and subsequent years at the University of Arkansas?____________________________________

_______________________________________________________________________________________________________________________________
14. If you do not meet our English proficiency requirement, are you interested in attending our on-campus intensive English program prior to your academic

program? Yes No, I will take/retake the TOEFL or IELTS and submit a new score.

By signing my name to this form, I certify that all of the information I have given is true, and that it correctly represents the funds available to
me. These funds can and will be used to finance my academic and living expenses at the University of Arkansas.

________________________________________________________________________________ __________________________

________________________________________________________________________
Applicant’s Signature Date

AFFIDAVIT OF SUPPORT
(To be completed by sponsor - attach additional pages if receiving support from more than one sponsor.)

In consideration of the admission of _________________________________________________________________________________________________

Student’s Name

who is my ____________________________________, as a student at the University of Arkansas for the academic year beginning ____________________,
Relationship Semester and Year

I certify that I am able, willing, and do promise to provide him/her with the minimum amount of USD $_____________________ for his/her expenses during

said academic year. Evidence of my financial resources in the form of a bank statement accompanies this affidavit of support.

___________________________________________________ ____________________________________________ ____________________

Name of Sponsor Signature of Sponsor Date

Address of sponsor: _____________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

This form must be accompanied by a bank statement unless you have enclosed an official copy or statement of your award from your sponsor.
Without the items mentioned above, your application will not be considered complete, and you will not receive the immigration Form I-20 or DS-2019.

You are advised to keep copies of all financial documents submitted to the University of Arkansas. Similar information will be required by the United States
Consular Office when you apply for your visa and, in come cases, by the Department of Homeland Security when you apply for a transfer within the United
States, issuance of dependent I-20s or DS-2019s for spouse or children, extension of an F-1 or J-1 program, or change of status to F-1 or J-1.

You may upload this completed form to your UAConnect applicant center by clicking the "Upload Documents" link.

Revised 11/17