The Graduate School North Carolina State University

Room 2300, Textiles Building 1000 Main Campus Drive

Campus Box 7102 Raleigh, NC 27695-7102

ckhester@ncsu.edu

2015-2016 CERTIFICATE OF FINANCIAL RESPONSIBILITY (CFR)

General Information: • Signatures and bank documents must be current (Issued less than 6 months prior to the submission date of your NCSU

Graduate School application). • I-20 or DS-2019 cannot be issued until this form has been approved by the Graduate School. Approval takes 1-2 business days.• Upload the completed CFR form to your online application, along with any supporting documents by using your application

PIN and password at http://www.ncsu.edu/applygrad. It may be uploaded in the “International Applicants Only” section.• Please also upload a copy of your passport identification page, to ensure your name matches on all your documents.• Retain a copy of the CFR and all documents submitted to the Graduate School for your records

Financial Information: • When a statement/letter is provided in place of section 4, it must include the bank’s official stamp or letterhead, printed

name, job title, and original signature of the financial representative and be written in English. Date of issuance must be clearly indicated on the statement or letter and the date must be within 6 months from the submission date of your NCSU Graduate School application. General letters or statements from Chartered Accountants, Solvency Certificates, deposit slips or passbooks are not acceptable. In addition, value assessments of properties or stocks/investments, salary information, mortgages, insurance policies, etc. cannot be accepted.

• You must be able to demonstrate at least $39,814 in support-$21,950 for tuition, $17,864 for living expenses (9 months for F-1) which includes Rent, Fees, Food, Books and Personal expenses. J-1 students must show at least $45,769 in support-$21,950 for tuition, $23,819 for living expenses (12 months for J-1) per each year as listed on the DS-2019. A student who plans to remain in the United States during the summer will need approximately $5,955 for living expenses. You should not expect employment, either part-time or full-time during summers to be a significant means of support. Please keep in mind that this is an estimate calculated well in advance of the actual start of the semester and these estimates are subject to change. You can anticipate a 4-8% increase per year. Applicants to the Master of Business Administration, Master of Accounting, Master of Global Innovation Management, the College of Design, Master of Analytics, Master of Financial Math, Master of Supply Chain Management, MSCPE, MSEE, MSEPSE, MSCN, MCS, MSCS and all Veterinary Medicine programs should expect to demonstrate additional funding due to the higher tuition rates.

• Health Insurance is a requirement for F-1 and J-1 students. All students will be enrolled in the Student Blue plan administered by BlueCross BlueShield. Students on a Teaching or Research Assistantship will have their health insurance covered by the Graduate Student Support (GSSP). Some students may qualify for a waiver of the Student Insurance plan (http://internationalservices.ncsu.edu/mandatory-insurance-hard-waiver-plan).

• Applicants who will receive an assistantship award should upload their assistantship letter in the CFR portion of their onlineapplication for review. If the award does not cover the entire international financial requirement you are responsible todemonstrate the difference in funding on a CFR before your admission can be processed. Most assistantship awards willinclude tuition and university health insurance; however a monthly stipend of at least $1,796 is necessary to meet theminimum requirement.

• An applicant who will be financially sponsored by his/her employer, home government or university, must provide anofficial letter of support, with the current date and a signature. The letter must explicitly list the amount awarded for livingexpenses. The letter should also include the applicant’s name, academic program and duration of award (2-3 years for aMaster’s degree and 4-5 for a Doctoral degree).

Fall Deadline: May 1Spring Deadline: October 1

Sponsorship by non-immigrants in a visa status which does not allow employment such as F-2, TD etc. may not be acceptable and will require further inquires.

•

The Graduate School North Carolina State University

Campus Box 7102 Raleigh, NC 27695-7102 ckhester@ncsu.edu

9 digit NCSU Student ID Number: _____________________________

2015-2016 GRADUATE STUDENT CERTIFICATE OF FINANCIAL RESPONSIBILITY

(TO BE COMPLETED BY INTERNATIONAL APPLICANTS SEEKING TO APPLY FOR AN F-1 OR J-1 VISA) Section 1: BASIC APPLICANT INFORMATION

Last name: _____________________________ Gender (please check one): [ ] Male [ ] Female

First name: _____________________________ Country of Citizenship: _____________________________

Middle name:_____________________________ Country of Birth: __________________________________

Date of Birth: (mm/dd/yyyy): _______________ Country of Permanent Residence:______________________

* Please Attach a copy of your passport validity and identity pages.

Section 2: VISA INFORMATION (PLEASE CHECK ONE):

( ) I request an I-20 for an F-1 student visa (for entry to the United States). ( ) I am already in the US in F-1 or J-1 student status and need to transfer. (Please also submit the Visa

Clearance Form and a photocopy of your current I-20 or DS-2019 and I-94 card—both sides). ( ) I request a DS-2019 for a J-1 visa. (You must be sponsored by a government or organization and not

relying primarily on personal or family funds). My occupation in my home country is ____________________________________________________.

My employer in my home country is (check one): __government agency __university __ private organization __ other (please name):_______________.

My city of birth is _________________________________. ( ) My DS-2019 will be issued by Fulbright: _____ Other (Please write in agency name: _______________).

Section 3: SPONSOR INFORMATION: To Be Completed By Sponsor: If a sponsor (relative or friend) will provide financial support for the applicant, the sponsor must complete this section of the CFR. Additionally, each account holder listed on a bank statement is required to sign as your sponsor. If you will have more than one sponsor, please make additional copies of this page of the form so that all sponsors can fill out and sign section 3.

By signing below, I certify that I have and will give $39,814* to this student for the first year and an amount equal to or greater than this for each subsequent year of his/her program.

NAME: _____________________ ____________________ _______________ _________________ (Last/Family Name) (First Name) (Signature) (Relationship to Applicant)

ADDRESS: ____________________________________________________________________________ Estimated funding for MBA, MGIM and Master's of Supply Chain Management is $52,424Estimated funding for Master of Financial Math is $45,814 Estimated funding for Master of Accounting is $51,064 Estimated funding for College of Design is $41,214Estimated funding for all Veterinary Medicine programs is $58,853Estimated funding for Master of Analytics is $49,814 Estimated funding for MSCPE, MSEE, MSEPSE, MSCN, MCS, MSCS is $43,014

Note: All account holders must sign as sponsor

Fall Deadline: May 1Spring Deadline: October 1

Room 2300, Textiles Building 1000 Main Campus Drive

Section 4: FINANCIAL DOCUMENTATION: A bank official must complete this section, or you may instead submit in its place an official bank statement or a bank letter written in English. See financial information on page 1 for instructions.

I certify the following information:

DEPOSITOR NAME: ________________________________

CURRENT BALANCE IN US DOLLARS _______________ TODAY’S DATE ____________________

AVERAGE BALANCE IN ACCOUNT (past year)___________ DATE ACCOUNT OPENED __________

FINANCIAL OFFICIAL’S NAME (print) ______________________ TITLE: ___________________________

FINANCIAL OFFICIAL’S SIGNATURE ___________________________________________________

FINANCIAL INSTITUTION NAME ______________________________________________________

FINANCIAL INSTITUTION ADDRESS: ___________________________________________________

FINANCIAL INSTITUTION STAMP OR SEAL (please stamp here):

*

Section 5: PERMANENT RESIDENTIAL ADDRESS IN HOME COUNTRY: (NO Postal Boxes)

Physical Street Address: ______________________________________________________________

City: __________________________________ Province/Territory/State: _____________________

Country: ____________________________ Postal Code: ____________________________

Section 6: IF IN US: CURRENT RESIDENTIAL ADDRESS IN THE UNITED STATES:

Address: ______________________________________________________________________

City: ________________________ State: ___________________ Zip Code: _________________

I certify to the best of my knowledge that the information I have submitted is accurate and true.

____________________________________ _____________________________ Student’s signature Date (mm-dd-yyyy)

*If you have dependents please fill out Section 8 (next page) and add the additional funding to your financialdocumentation

After you have completed the CFR form please upload it to your online application along with any supporting documents by using your application PIN and password at http://www.ncsu.edu/applygrad. If you have problems uploading your documents, please visit our FAQ at http://ncstategraduateschool.custhelp.com/ and type in the keyword “file size”.

Fall Deadline: May 1Spring Deadline: October 1

Section 8: DEPENDENT INFORMATION: If you plan to bring your spouse and/or child(ren) with you, you must show additional funding (F-1, $6,000 for your spouse and $4,000 for each child, J-1, applicants, the additional amount to be shown for a spouse is $7,800 and 4,200 for each child.). Please print legibly. If you have more than 4 dependents, you may use an additional copy of this page.

Last/Family Name :______________________________ Last/Family Name:______________________________

First Name :____________________________________ First Name :____________________________________

Middle Name :__________________________________ Middle Name :__________________________________

Date of Birth (mm/dd/yyyy)________________________ Date of Birth (mm/dd/yyyy)________________________

City of Birth:____________________________________ City of Birth:____________________________________

Country of Birth:_________________________________ Country of Birth:_________________________________

Country of Citizenship:___________________________ Country of Citizenship:____________________________

County of Permanent Residency:____________________ County of Permanent Residency:____________________

Relationship to Applicant:__________________________ Relationship to Applicant:__________________________ ________________________________________________________________________________________________________

Last/Family Name :_______________________________ Last/Family Name :_______________________________

First Name :_____________________________________ First Name :_____________________________________

Middle Name :___________________________________ Middle Name :___________________________________

Date of Birth (mm/dd/yyyy)________________________ Date of Birth (mm/dd/yyyy)________________________

City of Birth:____________________________________ City of Birth:____________________________________

Country of Birth:_________________________________ Country of Birth:_________________________________

Country of Citizenship:____________________________ Country of Citizenship:____________________________

County of Permanent Residency:____________________ County of Permanent Residency:____________________

Relationship to Applicant:__________________________ Relationship to Applicant:__________________________

Fall Deadline: May 1Spring Deadline: October 1