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CERTIFICATE OF ELIGIBILITY (I-20) APPLICATION & AFFIDAVIT OF SUPPORT
2015 SUMMER HUMAN RIGHTS INSTITUTE (SHRI)
In order to receive the Certificate of Eligibility (I-20) needed to obtain a visa, international students must provide evidence that they
have financial support to cover at least: $2600 program fee + $1000 USD for living expenses.
1.
Full Name:
2.
Mailing Address:
3.
Permanent
Address:
(as on passport)
Last/Family Name
This is the address to
which your I-20
will be sent
In home country, if
different from mailing
address above
4.
City and Country
of Birth:
6.
Date of Birth:
First/Given Name
Middle Name(s)
House/Building Number
Street
Apt/Suite Number
City
State/Province
Country
House/Building Number
Street
Apt/Suite Number
City
State/Province
/
/
5. Country of
Citizenship:
Postal Code
Country
Postal Code
7. Country of Permanent Residence:
8. Telephone:
9. Gender:
With country + city codes
 Male
 Female
10. Email Address:
11. If you are presently in the United States (US), what is your current immigration status?
Please note ‘pending permanent residency’ is not a status.
12. Do you intent to pursue an academic program in the US before or after the SHRI?
If yes, please attach a brief statement of explanation.
 Yes
 No
13. It is recommended that you arrive in the US and find a suitable accommodation for your family before they join you. However, if
your spouse and/or children will accompany and stay with you, please provide the following information for each family member on
a separate sheet: Name, relationship to you, date and country or birth.
14. Please indicate the source and amount of your financial support. You must document support of at least $3600USD:
Sources of Support
Required Documentation
1.
Personal Funding
2.
Parent, Sponsor or Employer
3.
Scholarships and Assistanceships
4.
Other Sources
Guaranteed Support in USD
•
Bank statements or letter showing sufficient funds*
US$
•
Signed affidavit (below) and bank statements showing
sufficient funds*
US$
•
Copy of award letter from sponsoring agencies
US$
•
Affidavit from authorized person and bank statements
if necessary
US$
*Bank statements should be current
TOTAL: US$
15. AFFIDAVIT OF SUPPORT: To be completed by parent or sponsor of applicant, see #2 (above). If more convenient, your sponsor may provide
an affidavit on a separate piece of paper.
I, hereby certify that I am willing, able, and do promise to provide the minimum amount of US$
for the educational expenses
of [Name of Student]
, who is my [Relationship to Student]
Fordham University. Bank statements or other proof of my financial resources accompany this affidavit of support.
Signature
Name (Printed)
Date
Email completed form and supporting documents to [email protected].
, at