Please TYPE and complete. Handwritten forms WILL NOT be accepted.
Important note: You must attach a CURRENT bank statement/letter IN ENGLISH and must be from a
CHECKING/SAVINGS/CERTIFICATE OF DEPOSIT account (*no stocks or investments) with an available
balance of at least $11,000 USD. Name on bank statement must match sponsor information below.
Student’s Information:
Student Name Gender Male Female
Student Family Name Student First Name Student Middle Name
Date of Birth Country of Citizenship Country of Birth
Telephone Number Fax Number
Email Address
Home Address
Number & Street City State/Province Country Postal Code
Sponsors Information:
Must be account holder’s name, as written on the bank statement/letter.
Mr. Mrs./Ms.
Last Name Sponsors First Name Sponsors Middle Name
Relationship to the Applicant Country of Citizenship
Telephone Number Email Address
Current Mailing Address
Number & Street City State/Province Country Postal Code
I, , certify that this adavit is made by me for the purpose of assuring Cloud
County Community College that I will take nancial responsibility, including but not limited to, education and
living expenses of the above mentioned student throughout the duration of his/her studies. I have enclosed the
required bank letter or statement indicating my ability to meet the expenses accrued by the above mentioned
I certify that all information in this form is truthful, to the best of my knowledge, and I further understand that it
is a violation of the United States law to give false information to the college.
X Date:
Sponsors Signature Month/Date/Year
Revised 9/2019