Financial Certification Form - Columbia University

Financial Certification Form

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Section 1: My Program Information

1a. My academic school, program, and degree: _________________ _______________________________ School, e.g. Business Program, e.g. Real Estate Development

______________ Degree, e.g. MBA

1b. My total expenses for the first academic year of my program as listed here: $____________________________ (if you're coming for one semester only, put half of the total expenses) ?

1c. My dependent(s)' total expenses for the first academic year of my program ?

$____________________________

1d. My First Academic Year's Total Expenses ?

0.00 $____________________________

Section 2: My Funding Sources (for My First Academic Year)

Descriptions of the types of documents you need to submit to us (along with this form) are included in this checklist:

Source A. My Personal Funds ?

$____________________________

Source B. My Parents, Family, and/or Friend's Funds ?

______________________________ ________________________________________

Sponsor #1's full name

Relationship - Parent, Sibling, Friend, etc.

$____________________________

______________________________ ________________________________________

Sponsor #2's full name

Relationship - Parent, Sibling, Friend, etc.

$____________________________

______________________________ ________________________________________

Sponsor #3's full name

Relationship - Parent, Sibling, Friend, etc.

Do you have another sponsor? ?

Source C. My Approved Awards, Grants, or Scholarships ?

Source D. My Approved Student Loans ?

Source E. My Employer's Sponsorship ?

Total Funding for My First Academic Year ?

$____________________________

$____________________________ $____________________________ $____________________________

0.00

$____________________________

ISSO Morningside | ISSO-CUMC |

Section 3: Acknowledgement

Student Acknowledgement

I, _______________________ certify that the funding sources listed in Section 2 will pay for my first academic year's tuition, fees, and living expenses.

Student's full name

___ I plan to complete my program in one academic year (two semesters) or less. Do not complete Section 4 on the next page.

__________________________________

Student's Ink Signature

________________

Date, MM/DD/YYYY

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Sponsor #1 Acknowledgement

I, ______________________ will provide the amount listed in Section 2, Source B for 1 2 3 or more year(s) of the academic program.

Sponsor#1's full name

Check one

__________________________________ ________________

Source B Sponsor #1's ink signature ?

Date, MM/DD/YYYY

Current Address ___________________________________________________________________________________________________________

Building number

Street

Apartment number

_______________________ ______________________________

City

Province

___________________________ Postal Code

_______________________________ Country

Email ________________________________________________________________ Telephone ________________________________________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Sponsor #2 Acknowledgement

I, ______________________ will provide the amount listed in Section 2, Source B for 1 2 3 or more year(s) of the academic program.

Sponsor#2's full name

Check one

__________________________________ ________________

Source B Sponsor #2's ink signature ?

Date, MM/DD/YYYY

Current Address ___________________________________________________________________________________________________________

Building number

Street

Apartment number

_______________________ ______________________________

City

Province

___________________________ Postal Code

_______________________________ Country

Email ________________________________________________________________ Telephone ________________________________________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Sponsor #3 Acknowledgement

I, ______________________ will provide the amount listed in Section 2, Source B for 1 2 3 or more year(s) of the academic program.

Sponsor#3's full name

Check one

__________________________________ ________________

Source B Sponsor #3's ink signature ?

Date, MM/DD/YYYY

Current Address ___________________________________________________________________________________________________________

Building number

Street

Apartment number

_______________________ ______________________________

City

Province

___________________________ Postal Code

_______________________________ Country

Email ________________________________________________________________ Telephone ________________________________________

ISSO Morningside | ISSO-CUMC | 2

Section 4: My Funding Sources (My Funding Sources for Future Academic Years)

Do I need to complete this section? If your program is longer than one academic year (or longer than two semesters). Why do I need to complete this? For multi-year programs you need to have reliable financial resources for the length of the program. How do I complete this? Use your school's estimated expenses (as listed on ) to complete the information below. You do not need to document these

resources at this time.

Source A. My Personal Funds ? Source B. My Parents, Family, and/or Friend's Funds ?

$____________________________

______________________________ ________________________________________

Sponsor #1's full name

Relationship - Parent, Sibling, Friend, etc.

$____________________________

______________________________ ________________________________________

Sponsor #2's full name

Relationship - Parent, Sibling, Friend, etc.

$____________________________

______________________________ ________________________________________

Sponsor #3's full name

Relationship - Parent, Sibling, Friend, etc.

Do you have another sponsor? ?

Source C. My Approved Awards, Grants, or Scholarships ?

Source D. My Approved Student Loans ?

Source E. My Employer's Sponsorship ?

$____________________________

$____________________________ $____________________________ $____________________________

Total Funding for each of my future Academic Years

0.00 $____________________________

I, __________________________________ certify that the funding sources listed above will pay for my future academic years' tuition, fees, and living expenses.

Student's full name

__________________________________ ________________

Student's Ink Signature

Date, MM/DD/YYYY

Section 5: Student Financial Services

Thank you for submitting your application for a COE to the ISSO. The information you are listing and documenting also may be provided to other university offices upon their request, such as your school's Financial Aid office or Student Financial Services (SFS).

SFS is the university office that provides information and methods for paying your bill. Please review their important information on the following topics:

Single Prepayment Plan: Columbia Institutional Loans and Disclosures: Private Loans:

If you have questions or require additional information, please contact SFS directly:

ISSO Morningside | ISSO-CUMC | 3

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