SEVIS
Financial/Health Statement
Instruction to Applicant (PLEASE PRINT): Please complete the form below and return to: Jan Willems, Director of International Programs, 1014 Boswell, Crete, NE, 68333.
The following statement must be signed by you, and if you are under 21 years of age, your sponsor.
"I understand that the total expenses for tuition and living costs will be approximately $30,500 (includes tuition plus travel, insurance, books, personal expenses) for 9 months of undergraduate studies at Doane College. I accept full responsibility for these expenses. In the case of illness and/or injury, I authorize full diagnosis and treatment by qualified professionals and release of medical information to them. I understand and agree to the policies and conditions of admission to Doane College."
| ________________________________________________________ | ____________________ |
| Signature of Applicant | Date |
| ________________________________________________________ | ____________________ |
| Signature of Sponsor if Applicant is Under 21 Years Old | Date |
| ________________________________________________________ |
| Relationship to Applicant |