Graduate International Student Declaration of Finance Form

This form must be completed by all students who are not U.S. citizens or permanent residents who intend to be enrolled full-time at Merrimack College. The form must be accompanied by current (no older than nine months) proof of funding for the first year of studies in the form of a notarized bank letter. The total costs that must be documented can be found upon selection of your program of study below.

Personal Data

Important: All personal information must be written exactly as it appears in your passport.

First/Given Name

Surname/Last Name

Birthdate

Country of Primary Citizenship

Country of Legal Permanent Residence

Contact Information

Email Address

Permanent Address Outside U.S.

Country

Street

City

Region

Postal Code

Visa History

Are you currently in the United States?

Yes

Which visa status do you currently hold?

Upload a copy of your most recent I-94 here

Upload a copy of your most recent I-20 here

Upload a copy of your F-1 visa here

Upload a copy of your DS-2019

Upload a copy of the I-797

Family & Dependent Information

Note that only the spouse and children under the age of 21 are eligible for a dependent visa. Are you seeking an I-20 for dependent family member(s) entering the U.S. with you?

Yes

Please note applicants with dependents must show additional proof of finances. We require $800/month for spouse ($9600 per year) and/or $400/month for each child ($4800/year).

How many dependents will be entering with you?

Dependent 1 Information

Dependent 1 Legal Name

Dependent 1 Date of Birth

Dependent 1 Relationship

Spouse

Child

Dependent 1 Passport Copy

Dependent 1 Birth Certificate Copy

Dependent 1 Marriage License

Dependent 2 Information

Dependent 2 Legal Name

Dependent 2 Date of Birth

Dependent 2 Relationship

Spouse

Child

Dependent 2 Passport Copy

Dependent 2 Birth Certificate

Dependent 2 Marriage License

Dependent 3 Information

Dependent 3 Legal Name

Dependent 3 Date of Birth

Dependent 3 Relationship

Spouse

Child

Dependent 3 Passport Copy

Dependent 3 Birth Certificate

Dependent 3 Marriage License

Dependent 4 Information

Dependent 4 Legal Name

Dependent 4 Date of Birth

Dependent 4 Relationship

Spouse

Child

Dependent 4 Passport Copy

Dependent 4 Birth Certificate

Dependent 4 Marriage License

Dependent 5 Information

Dependent 5 Legal Name

Dependent 5 Date of Birth

Dependent 5 Relationship

Spouse

Child

Dependent 5 Passport Copy

Dependent 5 Birth Certificate

Dependent 5 Marriage License

Program Estimated Costs

To be issued a student visa eligibility document (Form I-20), proof of funding for the first year of tuition, fees, and living expenses must be provided. The total available funds must exceed or equal the following estimated costs of your specific program.

Please Select your Program of Interest to see the estimated cost of attendance for one year. This is the amount of funding you will need to show in order to be issued an I-20.

**Biology, Communication, Exercise and Sport Science, Health Promotion and Management Estimated Program Costs**
Tuition	$35,200
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$65,211 USD

**Applied Chemistry Estimated Program Costs**
Tuition	$36,480
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$66,491 USD

**Speech Language Pathology Estimated Program Costs**
Tuition	$36,480
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$69,161 USD

**Accounting, Business Analytics, Finance, Leadership, Management, Civil Engineering, Mechanical Engineering Estimated Program Costs**
Tuition	$22,400
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$52,411 USD

**School Counseling Estimated Program Costs**
Tuition & Fees	$16,200 (one-year)
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$46,211 USD

**Clinical Mental Health Estimated Program Costs**
Tuition & Fees	$33,000
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$63,011 USD

**Spirituality and Spiritual Direction Estimated Program Costs**
Tuition	$23,200
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$53,211 USD

**Teacher Education, Community Engagement Estimated Program Costs**
Tuition	$27,540
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$57,551 USD

**Athletic Training Estimated Program Costs**
Tuition & Fees	$33,400 (one-year)
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$63,411 USD

**Social Work, Nutrition and Human Performance Estimated Program Costs**
Tuition	$30,800 (one-year)
Living Expenses	$23,000
Health Insurance	$3,911
Books	$1,500
Fees	$1,600
Total	$60,811 USD

Currently Merrimack College does not issue I20's for certificate programs.

Currently Merrimack College does not issue I20's for our online programs.

Financial Certification

Please indicated your funding sources. Select all the apply:

Please list the funding amounts below. Amounts should be listed in US Dollars and should total the estimated program cost listed in bold above.

Merrimack College Funds
Note: List any aid awarded by Merrimack which may include housing grants, merit scholarships, and/or athletic aid.

Government Agency Funds

Family Funds

Sponsor Funds

Personal Funds

Educational Loan Funding

Total Funding Amount
Note: This amount should match or exceed the estimated annual cost listed above in bold for your program of study

Parent, Family, or Sponsor Information

If you are supported by family funds or another sponsor you must submit a notarized bank letter that specifies a dollar amount. This figure does not need to be the total amount in the account, just an amount in excess of the total financial certification.

Parent, Family Member or Sponsor Full Name

Parent, Family Member or Sponsor Email Address

Parent, Sponsor, or Family Member Notarized Bank Letter

Government Agency Funding Letter

Notarized Bank Letter for Personal Funds

Proof of Education Loan Funding Letter

By signing and submitting this form, I confirm the information & documentation I provided shows that I have the financial holdings to cover the expenses to study at Merrimack College.

Click to Sign...