Intensive English Language Program
211 1700 North Broad Street
Temple University
Philadelphia, PA 19122
Telephone: 215 204 7899
Fax: 215 204 3892
                                                                        E-mail: ielp@temple.edu

 

Temple University
Intensive English Language Program
Financial Certificate


If you submit this form by e-mail, please send it directly to the Intensive English Language Program by e-mail at ielp@temple.edu.  Applications received by e-mail will be processed, but responses and documentation will be kept in the Intensive English Language Program office until the application fee and ORIGINAL BANK CERTIFICATE are received by the Intensive English Language Program. YOU, THE APPLICANT, MUST COMPLETE THIS FORM AND SIGN AND DATE IT AT THE BOTTOM.

SOURCE OF SUPPORT                                                                           AMOUNT (IN U.S. DOLLARS)

I.   Personal and/or Family Savings                                                           $___________

       Name of Bank ________________________________________________

       Bank Address_________________________________________________

      _________________________________________________________________________
       City                          State/Province                    Country                              Postal Code

II.  Parents and/or Sponsors                                                                       $____________

       Name(s) of Parent(s)___________________________________________

        Name(s) of Sponsor(s)    ________________________________________

       Relationship of sponsor to student  _________________________________

       __________________________________________________________
       Parents' or Sponsor's Address

       ________________________________________________________________________
       City                          State/Province                    Country                                     Postal Code
 

III. Government or Other Agency                                                               $ __________

       Name(s) of Sponsoring Agency ____________________________________

        __________________________________________________________
       Sponsoring Agency Address

       _________________________________________________________________________
       City                          State/Province                     Country                                 Postal Code
 

NOTE:     If you are sponsored by a government or other official agency, please provide a signed copy of your award letter.

IV.  Other (Please specify and indicate name and address below)    $____________

       Name ____________________________________________________

        ________________________________________________________
       Address Line

       _______________________________________________________________________
       City                              State/Province                      Country                               Postal Code

 

By submitting this form to the Temple University Intensive English Language Program and an ORIGINAL bank statement DATED WITHIN 6 MONTHS OF THE START DATE OF THIS PROGRAM, I certify that the total amount of money that I have available for my first academic term of study at the Temple University Intensive English Language Program is a minimum of U.S. $9500.00 and that the total amount available for each subsequent term of study is sufficient. Further, I certify that the above information provided is correct and complete and that I shall notify the Temple University Intensive English Language Program of any change in my financial status. Application fees and health insurance fees are non-refundable; tuition refunds are based on the Temple University refund policy.

____________________________________________________________
First Name                              Middle Name                                           Last/Family Name

_________________________________                                   ___________________
Signature                                                                                                     Date

 

 

 

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