UC International
University of Cincinnati
PO Box 210640
Cincinnati, OH 45221-0640
Room 3134, Edwards One
Phone (513) 556-4278
Fax (513) 556-2990

Financial Certification Form
Personal Information: Please put your name in full as it appears in your passport.
Family/Surname:___________________________________________________________________________
First/Given: ______________________________________ Middle: __________________________________
Country of Birth

Date of Birth

_____________________________

______/______/______ month day

Country of Citizenship
____________________________________

year

Are you currently in the United States? ___YES ___NO If yes, list immigration status:_____(F1, H1B, etc.)
If Yes, and the immigration status is not F-1, the Form I-20 or DS-2019 will not be issued until you have made an appointment with us for assistance with a change of status application. If you are not eligible for a change of status, the form will only be issued for travel to your home country.
E-mail: __________________________________________ Telephone: _______________________________
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Mailing Address for I-20 or DS-2019: Street Address:_____________________________________________
__________________________________________________________________________________________
City:_______________________________________ Province ______________________________________
State/Country______________________________________ Zip/Postal Code: _________________________
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Funding Information: The total support necessary for first year of study must be documented and available. The support necessary for subsequent years of study must be reasonably attainable and documented through bank statements, employment letters, tax