BREVARD COMMUNITY COLLEGE
INTERNATIONAL STUDENT APPLICATION
APPLICANT INFORMATION
Last (Family) Name: First Name:
Middle Name:
Date of birth: Country of Birth: Country of Citizenship:
Telephone:
Social Security Number*:
Gender: Male Female
*In compliance with Florida Statute 119-07(1): SSN is requested for the sole purpose of registering non-credit, continuing education
students. SSN’s are confidential, are immediately converted to student ID or “B” number to ensure confidentiality and may be used for
no other purpose. SSN’s may only be disclosed to another agency or government entity if necessary for the receiving agency or entity
to perform its duties and responsibilities as authorized by law.
Home Country Address (Street or postal address):
City: Postal Code:
Country:
Session for which you are applying: Spring Session (Jan-Apr) Summer Session (May-Aug) Fall Session (Aug-Dec)
FINANCIAL SUPPORT INFORMATION
Brevard Community College is required by the U.S. Citizenship and Immigration Services (USCIS) to assure that applicants are able to
pay charges and living expenses while studying at the College.
Please indicate the source and amount of funds for your first academic year (minimum of $22,000.00).
$ Personal Funds: You will need to submit an original bank statement (or similar document) provided by your bank
verifying this information.
$ Scholarship: If you have a scholarship or financial support from an organization, we will need a Letter of Financial
Guarantee addressed to Brevard Community College. The letter must state the period of coverage.
$ Family of Other Support: You must provide the following statement signed by the person who will be responsible
for your expenses whole you are at Brevard Community College:
Student’s name:
Sponsor’s name: Sponsor relationships to student:
Address:
Country: Phone Number:
I hereby certify that I will be financially responsible for the expenses of the above-referenced student during his/her stay at
Brevard Community College. I am able to provide the amount indicated above for one academic year.
Sponsor’s Signature: Date:
Plea
se
be sure to attach bank statements, letter from bank official, letter from your employer or other documents verifying
your ability to cover the student’s expenses.
Signature of Applicant: Date:
Complete and Return to:
English Language Studies • Brevard Community College • 250 Community College Parkway • Building 1-Room 306A
Palm Bay, Florida 32909
Telephone: (321) 433-7516 • Fax (321) 433-5317 • e-mail: els@brevardcc.edu
• web site: www.brevardcc.edu/els
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