International Student Services

Division of Student Success Center

2022-2023 F-1 Declaration of Financial Support

The Department of Homeland Security (DHS) requires that all F-1 students show proof of financial support for each year of university
study in the United States. To meet this requirement, all F-1 students must submit:

1. A financial affidavit signed by the student and sponsor(s).

2. A bank statement or other comparable evidence of financial stability. This official document must be dated within six months of
the start of the semester and be signed, dated and stamped by bank official.

The current minimum amount required per academic year is $23,500 for a student even if receiving any scholarship
assistance (add $5000 for your spouse and $3000 for each child listed as your dependent). These amounts are subject to change
without prior notice. This form should be used only by students who are sponsored by self, family members, or personal friends. Those
who have official government or agency sponsors should submit their sponsor documents.

Please mail all official financial documents to the following address: Delta State University
International Student Services
1003 W. Sunflower Road, DSU Box 3232
Cleveland, MS 38733
STUDENT PERSONAL INFORMATION:

Name:
Family Name First Name Middle Name

U.S. Address (if applicable):

Permanent Non-United States Address (required):

Street Apartment #

City Territory/Province Country Postal Code

Home Phone (Include Area Code): Email Address:

Field of Study: Degree Sought:

Expected Date of Enrollment: Fall Spring Year:

Immigration Information:

Are You Currently in U.S.? Yes No

If Yes, Which Immigration Status? F1 F2 J1 J2 Other (Specify Type):

Admission (I-94) Number:

Town/City and Country of Birth: Country of Citizenship:

Date of Birth (MM/DD/YY): Marital Status: Single Married

Please Check Appropriate Box: I plan to come alone to the U.S.

I plan to have my dependents come later to the U.S.
I plan to bring dependents with me.

Please Complete If Bringing Dependents to the U.S.:

Family Name First Name Relationship Date of Birth Country of Birth
(MM/DD/YY)

Continued on Next Page…

For additional information, please contact International Student Services, [email protected].
F-1 Declaration of Financial Support, Page 2

Student Name:

FINANCIAL SUPPORT VERIFICATION:

B. FINANCIAL SUPPORT VERIFICATION
Financial Sponsor(s): Total support from sponsors must be a minimum of $23,500.

Sponsor 1:

I have read the estimated budget for DSU international students listed below, and I agree to support the student named
above for a period of year(s) in the amount of $ USD per year.

Name:

Address:

Relationship to Student:

Sponsor 1 Signature: Date:

Sponsor 2 (If Applicable):

I have read the estimated budget for DSU international students listed below, and I agree to support the student named
above for a period of year(s) in the amount of $ USD per year.

Name:

Address:

Relationship to Student:

Sponsor 2 Signature: Date:

ESTIMATED INTERNATIONAL STUDENT FEES AND EXPENSES FOR 2022-2023 ACADEMIC YEAR*:

International Student Tuition (Undergrad: 12-19 Hours. Graduate: 9-13 Hours) $ 9,435
(Hours above maximum number requires overload fee per hour)
Books, Fees and Supplies $ 1,573
Residence Halls (Double Occupancy) $ 5,250
Meals $ 3,692
Required DSU International Student Health Insurance $ 1,600
Required International Student Fee $ 600
Required New Student Orientation Fee $ 40
Required TB Screenings (IHL Mandated Upon Arrival Prior to Start of Classes) $ 110
Personal $ 1,200
TOTAL*: $ 23,500

*This is an estimate of minimal expenses only. Fees are subject to change at any time without prior notice. This budget does not
include travel to and from the home country or vacation travel in the U.S.

STUDENT DECLARATION:
DECLARATION
I have read the estimated budget for international students listed above, and I understand that my admission to Delta State University is
contingent upon my ability to pay all expenses during my attendance. I also understand that if I cannot meet my financial obligations, or
if it becomes evident that I have acted in bad faith in making this declaration of financial support, I may be withdrawn from school. I
further certify the information submitted on this declaration is complete and accurate, and that submission of inaccurate information can
be considered sufficient cause for terminating my application or enrollment to Delta State University.

Student Signature: ________________________________________________ Date: ________________________

Updated 05/19/2022
For more information, contact International Student Services, [email protected].