AY CERTIFICATION OF SOURCES OF FUNDS FORM
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1 Certification of Sources of Funds_AY Page 1 The Fletcher School of Law and Diplomacy_ Who should complete this form? 1. Student who is admitted by the Fletcher School of Law and Diplomacy for the Fall 2016 semester enrollment without any conditions (e.g.: enrolling to an ESL program, taking a foreign language course during Summer 2016); and 2. Student who needs to obtain an US non-immigrant visa, such as F-1 or J-1 visa, in order to pursue full-time based study at Fletcher School If one of the following descriptions applies to you, you DO NOT need to complete this form, and submit Fletcher School Data Form along with a copy of your passport, visa stamp and most recent I-94 record printout: student who is United States citizen or have an US passport; US permanent resident (so called Green Card holder); currently under Temporary Protection Status (TPS), pending Asylum/Refugee status or similar status under the US immigration category; possess a valid visa and its status based on employment, such as A, E, G, H, I, L, O, P, R, TN visa or its dependent visa; possess a valid J-2 visa status from either from Fletcher or a different US academic institution; How to complete this form? Please fill out all applicable sections, including financial sponsorship section Please submit separate funding documents regarding ALL of your financial sponsors, including Fletcher scholarships, financial loans, non-fletcher scholarships and personal funding. In order to submit valid funding documents, please refer CERTIFICATION OF SOURCES OF FUNDS AY Funding Documents Information page Submitting incomplete form or invalid documents will delay process of issuing I-20s or DS-2019s. If you have any questions about the form submission, please Reiko Morris: reiko.morris@tufts.edu How to Submit Form Scan the completed form along with all applicable documents and send them via to Reiko Morris: reiko.morris@tufts.edu. If you would prefer sending the original documents via airmail or international express courier, please send them to Reiko Morris, International Student Advisor Office of Registrar, The Fletcher School of Law and Diplomacy, Tufts University 160 Packard Ave., Medford, MA U.S.A (Phone) (1) Deadline Friday, May 27, 2016 in the U.S. Eastern Standard Time (by and mail submission) IMPORTANT If you are expected to enroll to an English as Second Language Program (either Tufts or non-tuts program) during Summer 2016 in order to be fully matriculated into a Fletcher program in Fall 2016, please do not fill out this form until you are ready to complete the ESL program. You need to obtain an I-20 from the ESL program first in order to apply for an F-1 visa. We will issue your Fletcher I-20 once you completed the English language program.
2 Certification of Sources of Funds_AY Page 2 The Fletcher School of Law and Diplomacy_ Personal Information Deadline for the Fall 2016 Semester Enrollment: Friday, May 27,2016 (U.S. Eastern Standard Time) [1] Name (Please write in the same English spelling as your passport, in CAPITAL LETTER) Last First [2] Female Male Prefer Not to Identify [3] Marital Status Single Married Other [4] Date of Birth: [5] Country of Birth: (City) [6] Country of Citizenship: [7] Country of Permanent Residency (if any) [8] Your passport is issued by (Name of Country) Expiration Date: *If you have more than one citizenship, please enter name of country that you will claim for the US visa application. [9] Address in Home Country: (City/Town/Village) (State/Province/Prefecture) (Postal Code) (Country) [10] Phone Number : (Country Code) [11] Admitted Program Information [12] Program: MALD MIB MA LLM PhD Exchange Program [13] Are you Dual-Degree student from the following school? Yes please check your school in below No please go to Question [14] CEIBS DA HEC IE ISB St. Gallen Other: [13-A] If you checked Yes above, have you already been admitted by your dual-degree school (other than Fletcher ) as of today? Yes I was admitted in (Month/Year) - Are you currently attending at the school above? Yes No When are you enrolling to your Fletcher program? Fall 2016 semester (September to December 2016) Spring 2017 semester (January to May 2017) Other I don t know No I have applied but haven t been admitted yet as of today Are you enrolling to Fletcher school first WITHOUT receiving the dual-degree school s admission result? Yes No When are you enrolling to your dual-degree program? (Month/Year) I don t know U.S. Visa Information Eligibility to Apply Please check one of the boxes below. If you are enrolling to the Fletcher School as Exchange Student, you must apply for F-1 visa. F-1 Visa apply for F-1 visa if your financial sponsorships are descripted in below (Description of Funds) If funds are based on/or combination of: student s own funds, family (parents, siblings), relatives, Fletcher scholarships, current employer (include non-us government offices), educational loan, non-governmental scholarship, personal friends J-1 Visa you are eligible to apply for Fletcher-Sponsored J-1 visa if your financial sponsorships are descripted in below (Description of Funds) If more than 50% of total estimated expenses (per year) are covered by one of the Fletcher School scholarship awards; or If more than 50% of total estimated expenses (per year) are covered by scholarships of an organization who is not a designated organization by the U.S. Department of States to issue DS-2019s (e.g.: educational scholarship of student s home country) ATTENTION J-1 student and his/her dependent (J-2 visa holder, spouse/child of J-1) MUST meet the J visa health insurance guideline that the U.S. Department of States mandates for its J visa applicants and bears in order to enable themselves to apply for the visa. Please submit the J Visa Health Insurance Requirement Information and Purchase Confirmation Form.
3 Certification of Sources of Funds_AY Page 3 The Fletcher School of Law and Diplomacy_ [15] Are you currently in the U.S. under a non-immigrant visa status as of today? Yes visa, valid until: (Date) *Put D/S if you are F or J visa status holder No please directly go to question [18] [16] If you are currently in the U.S., do you need to apply for a different visa than the current visa in order to enroll to the Fletcher School? Yes Filing a change of status in the U.S. Yes Return to home country and apply at U.S. Embassy No* *If No, are you an international student (F-1 or J-1) of a different institution than the Fletcher School? Yes N SEVIS ID no. (I-20 or DS-2019) Name of Institution Date of I-20 or DS-2019 End Date No I am not an international student. I have a visa status that allows me to pursue full time study in the U.S. [17] Do you need to obtain a new Certificate of Eligibility (with new SEVIS ID number) from Fletcher? Yes required to pay a SEVIS Fee (I-901 Fee, $200) online and may need to apply for a new visa No, I will request my current institution to transfer my SEVIS record to Fletcher Transfer Form submission required [18] Do you need to request a Certificate of Eligibility (I-20 or DS-2019) for your dependent(s)? Yes please fill out the Dependent Information Sheet and attach a copy of your dependent(s) passport Additional funds for your dependent(s) required No please go to [19] Shipping Preference for Receiving Certificate of Eligibility (I-20 / DS-2019) [19] Would you like to receive your Certificate of Eligibility (I-20 or DS-2019) by Fed-Ex? (Recommended) Yes - we will charge the cost to your Tufts University billing account No - we will send it by the United States Postal Service (regular air-mail or domestic mail service, no tracking number available) [20] Do you wish to receive your Certificate of Eligibility (I-20 or DS-2019) at your home country address (as you listed on page 1)? Yes No, please send to the following address: (Street/Road) Phone : (Town/City) (Province/State/Prefecture) (Postal Code) (Country) (Country Code) Please Note The Fletcher School uses Fed-Ex ( as our international courier service provider, and it is required to provide the recipient s phone number. Please make sure to provide us your phone number with country code if you would like to receive your documents by Fed-Ex delivery. Once your documents is ready to be sent, we will you document sending notification with a Fed-Ex tracking number, shipping cost and estimated delivery schedule. Your Fed-Ex shipping fee will be directly charge to your Tufts University Student Account along with your first tuition and fee payment. Please be aware that we cannot provide tracking number or estimated delivery schedule for your mailing if you prefer receiving it by regular airmail (mailed by the United States Postal Service). No shipping fee will be charged to you for regular airmailing delivery.
4 Certification of Sources of Funds_AY Page 4 The Fletcher School of Law and Diplomacy_ [21] Document Submission Check List Please check box of documentation that you need to submit. Your Certificate of Eligibility (I-20 or DS-2019) will be issued once all the required documents are submitted to the Fletcher School: Required for ALL Student for BOTH F and Fletcher-Sponsored J visa applicants Official Certification of Sources of Funds and Amount Form completed, signed and certified by all necessary parties Copy of a valid passport (with minimum 6 months of validity ) Separate Funding proof; (such as personal bank statement, scholarship award letter, government financial assistant statement, private educational loan statement/guaranteed letter) Required for Fletcher School Sponsored J-1 Visa Applicant only for J visa applicants J Visa Health Insurance Requirements Information and Purchase Confirmation Form Required for Student who Transfers from Another U.S. Institution (F-1 students only, including Tufts Language Institute) Addition to the above-mentioned documentations; Fletcher School International Student Transfer Form request it to the Fletcher School Registrar s Office Copy of all previous I-20s from current US Institution Copy of visa stamp Most recent I-94 (Arrival/Departure) record print-out *Download from CBP web site ( Copy of EAD Card for OPT employment if applicable Copy of your dependent(s) previous I-20 from current US Institution If applicable Copy of your dependent(s) visa stamp if applicable Required for Student who Accompanies Dependent(s) Addition to the above-mentioned documentations; Copy of a valid passport (with minimum 6 months of validity ) of all dependent(s) Required for Student who Accompanies Same-Sex Spouse Copy of marriage certificate must be written in English or with a notarized English translation (NOTE FOR SAME-SEX MARRIED COUPLE) On June 26, 2013, the United States Supreme Court ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional. The Department of State, Bureau of Consular Affairs has advised consulates (the US Embassy or Consulate) that their officials may issue derivative visas based on same-sex marriage if the marriage is recognized in the place of celebration. That is, if the country where the couple married recognizes same-sex marriage as legal, then the U.S. government will recognize the union as legal for visa issuance, irrespective of where the couple plans to reside. The Fletcher School may issue a Certificate of Eligibility (I-20 or DS-2019) to your same-sex spouse of for his/her F-2 or J-2 dependent visa application, once the marriage is verified. Please sign below if you are ready to submit all necessary documents listed above By signing below, you are confirming that you have furnished ALL required documents and information, including available funding from your sponsor(s), to request the Fletcher School to issue an I-20 or DS-2019 for your F or J visa application. Student s Full Name (please print) Student s Signature Date
5 Certification of Sources of Funds_AY Page 5 The Fletcher School of Law and Diplomacy_ Academic Year Estimate of Expenses These figures are based on a nine month of stay (except Semester-Based Exchange Program) Final figures are subject to approval by the Board of Trustees of Tufts College in May 2016 Degree Program Tuition /Fees Room & Board 1 Health Insurance 2 Health Services Fee 3 Books, Supplies &Personal 4 Total MA $43,712 $14,500 $2,522 $784 $4,000 $65,518 LLM MALD MIB 51,164 14,500 2, ,000 72,970 Direct- 43,712 14,500 2, ,000 65,518 Admitted PhD Internally 21,856 14,500 2, ,000 43,662 Admitted PhD 5 Semester- Based Exchange , ,000 10,558 IMPORTANT NOTE US Federal immigration does not allow international students under F-1 or J-1 visa to seek for off-campus employment without having an authorization, and F-1/J-1 students are also not eligible to apply for Social Security Number until he/she obtains a valid employment, such as on-campus employment. (eligible to work up to 20 hours/week during regular academic term.) All incoming international students who are enrolling to The Fletcher School must be able to certify his/her financial sponsorship(s) clearly and accurately, and the funds must be 100% available for the student to use from the date when students to submit Certification of Sources of Funds Form through the end of academic year. International student AND the Fletcher School are required to report to the US Immigration and Customs Enforcement (ICE), if/when the student s funding source, amount, sponsor or any financial related condition changed. This rule applies to any F-1 or J-1 visa status holders, and whenever it occurred; before or after the student obtains an US student visa, the student arrives in the US, and the student enrolled to the Fletcher School. Please report Reiko Morris immediately when your funding sponsorship changed after receiving an I-20 or DS-2019: reiko.morris@tufts.edu Valid off-campus employment for F-1 or J-1 visa status holder are extremely limited, and eligibilities to apply for such employment are generally only for the graduating students. Incoming international students are responsible to estimate all necessary costs adequately in the case of unexpected fiscal circumstances. ESTIMATED COST FOR DEPENDENT Spouse (wife/husband): $5,000 per 9 months Child (must be younger than 21 years ole): $4,000 per 9 month per child *All dependent are required to purchase valid, US health insurance policy. For obtaining more information about University insurance policy for dependents, please go to the following web site: REMARKS 1. Estimated living expenses for off-campus living costs in Medford/Somerville area per 9 months. All international students need to be able to prove the same amount of cost as their Room & Board estimate when applying for I-20 or DS-2019, even if the student is chosen to live at Blakeley Hall from end of August. 2. All international students who are enrolling to Fletcher School program are REQUIRED to purchase Tufts University health insurance. If you are applying for J visa (both J-1 and J-2,) your DS-2019 cannot be issued unless you to confirm your purchase of the University health insurance plan on J-1 Exchange Program: Fletcher-Sponsored Students J- Visa Health Insurance Requirement Information and Purchase Confirmation Form. 3. University Health Services Fee is mandated for ALL Tufts University students to pay, including Semester-Based Exchange Students. 4. Estimated cost for utilities usage, books and supply purchases only. 5. Internally Admitted PhD students are: students who have completed a Master s program at the Fletcher School prior to their admission to PhD program. They are normally required to complete two semesters of course taking in order to transfer to Dissertation Continuation status at the Doctorate program.
6 Certification of Sources of Funds_AY Page 6 The Fletcher School of Law and Diplomacy_ The Fletcher School of Law and Diplomacy Academic Year (AY) Affidavit of Support Form This form needs to be completed by financial sponsor of incoming international student who is enrolling to AY Fletcher School academic program. If the student has more than one funding sponsor, each of them must complete this form. For the student s personal fund, please write the student s name and put Self under Relationship to Student column. If the sponsor is an organization or group, such as the student s current employer, scholarship offering organization, or educational loan provider, please indicate it in below. Regardless of the sponsorship, each guaranteed funds need to be certified on a separate document, such as bank statement, scholarship offer letter, admissions statement with scholarship information, employer s funding guarantee letter, educational loan approval letter. For more detail about valid funding documents, please refer Certification of Funds Form Funding Documents Information page. 1. Name of Student (Last Name) 2. Is Student s Sponsor Organization or Group? Yes No (First Name) 3. If Yes, please check one of the following Employer Non-Governmental Scholarship Provider (include Fletcher School) Home Government Educational Loan Other *If sponsor is an organization or group, you don t need to continue beyond this point. Attach a separate funding document, and sign the bottom of the form to certify the accuracy of information that you provided here. 4. Name of Sponsor (Last Name) (First Name) 5. Relationship to Student 6. Mr. Mrs. Ms. Other 7. Contact Information of Sponsor Street City/Town State/Province/Prefecture Postal Code Country Phone Number (include country code) Address (if any) Certification by Financial Sponsor I guarantee to provide the above-named student with the following amount of fund for the student s education related cost for his/her study at the Fletcher School of Law and Diplomacy in the academic year : (Total) US$ I attest that the above-mentioned fund is available for the student upon the request, and this funding information can be verified in a separate document that I have provided with this form. I certify the separate document has been issued within 3 months from today. Additionally, I understand that I am responsible to notify the student promptly when my financial sponsorship became unavailable. Name of Sponsor (Print) Signature of Sponsor Date STUDENT CERTIFICATION I hereby certify that information I provided on this form as well as the attached funding sponsor information are true and accurate. I understand my responsibility to notify the Fletcher School with any sponsorship changes prior and during my study at the institution. Student s Name (Print) Student s Signature Date
7 OF Fu n d in g Do cum e nts In fo rm a tio n Funding Source and Amount Please list all applicable funding information. Funds and financial sponsorship information that you list on this form will be reported to the U.S. Department of Homeland Security, and must be available, in full, upon your arrival at The Fletcher School. (IMPORTANT) 1. Please attach separate document(s), such as bank statement and scholarship letter, of all of your funding sources to this form. If you are granted scholarships, please attach a copy of your scholarship information/document (for Fletcher Scholarship, a copy of admission letter) or printouts. 2. If you will are using an educational loan as a part of your funding, you may submit application confirmation/statement. However, your I-20 or DS-2019 cannot be issued until your loan approval statement/confirmation is submitted to the Fletcher School. 3. We do NOT accept any of the following documents for I-20 or DS-2019 issuances: investment portfolios; retirement plans; available lines of credit (including credit card) ; deed to real state; leases with rental income; salary agreements or paystubs; income tax forms; public provident funds 4. Funding document(s) must be issued within 3 months from the date you fill out this form. 5. Amount of funds can be in a foreign currency. But it must be stated in numeric figures (e.g.: 1,800,000, 65,000) 6. If your funding information is only in a foreign currency, please attach foreign currency exchange printouts from an internet currency exchange site (e.g.: XE.com.) Otherwise, we will obtain currency exchange rate information of the date when your I-20 or DS-2019 is issued. 7. We do NOT accept funding document that is written only in non-english language. If needed, please attach an English translation of the document (doesn t need to be notarized.) Otherwise, your Certification of Funds Form will be sent back to you as invalid documents. 8. Any missing documents, information or submitting invalid documents can make your I-20 or DS-2019 issuance delayed. If you have any questions related financial sponsorship, funding and any other financial-related questions, please contact Reiko Morris: reiko.morris@tufts.edu as soon as possible Certification of Sources of Funds and Amounts-Funding Documents Information Page The Fletcher School of Law and Diplomacy_382016
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