Financial Affidavit
Name of Applicant (Please Print): ________________________________________________________
First/Given Name Surname/Last/Family Name
entral Community College (CCC) requires a financial affidavit from all applicants who are requesting an I-20. This
information must be received by CCC before the I-20 can be issued. No exceptions will be made. Supporting documents
must be original. All documents provided in support of the financial affidavit become the property of CCC and will not
be returned.
1. P
rint all pages and complete all sections on page 2 and 3 of this document. 2. Supporting official bank letter or
bank statement showing adequate financial support must be:
a. in English
b. stamped or signed by a bank official
c. in US currency
d. dated within six months of your CCC start date
e. in a savings or checking account. CCC cannot accept money markets, investments, or letters from
employers about salaries
-1 students are required to be full-time students, enrolled in a minimum of 12 credit hours each semester, except for
authorized reduced course loads or vacation quarters
Currently tuition and fees can be found at
Section 1. Statement of Financial Support (Student completes)
The total expense for an unmarried international student is estimated to be $19,180.00 for a twelve month academic year.
A married student who is accompanied by spouse and children will have considerably greater expenses.
ources and amounts of financial support for each year will be provided in the following manner:
a. Student’s Personal Funds $___________________________________
(Write the amount of support and provide supporting bank documentation)
b. F
unds from Family or Others $___________________________________
Name/Relationship of sponsor___________________________________________________________
(Write the amount of support and provide supporting bank documentation)
c. F
unds from another source, write name of agency (government agency, private foundation, bank, or other agency)
Write the amount of support and provide a signed letter from the agency specifying the amount funding $___________
d. Funds from Central Community College $___________________________________
Source of funds__________________________________________________________________________
TOTAL (Financial support from all sources must equal $19,180.00) $___________________________________
I certify I will have a minimum of $19,180.00 in U.S. currency available to me for each academic year I am studying at
Central Community College. By signing my name to this form, I certify that I can make the necessary arrangements to
have these funds transferred to the United States on a regular basis and that the information I have provided is correct.
Applicant’s (student) Signature:________________________________________Date:___________________________
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Shared documents/international forms/financial aff Revised 11/2012
Section 2. Verification of Financial Support (to be completed by financial sponsor).
This affidavit is made by me for the purpose of assuming the U.S. Government that the person named above will not
become a public charge of the United States. I understand this form may be made available to any Federal, State or local
agency that may receive an application from the above and/or their dependents for various government subsidies and that
my income and assets may be considered in deciding the individual named above and/or individual’s dependent’s
application(s). I understand that by endorsing the affidavit I am obligating myself, or my government or agency as its
representative, to make the current minimum sum of expenses estimated by CCC for I-20 purposes available to the
student. I certify under penalty of perjury under United States law that I know the contents of this affidavit singed by me
and that the statements are true and correct. _________
You Initial the line
I am attaching a CURRENT and OFFICIAL statement from my bank attesting to my financial status. I hereby guarantee
without reservation to maintain and support above mentioned student with education costs and living expenses while this
student is enrolled at Central Community College. I understand that the applicant, if accepted at Central Community
College, will be a full-time student who may not accept off-campus employment unless permission is granted by
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