Fillable Form 125-393: No I Northern Virginia ~IA 'WN (Northern Virginia Community College)

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Form 125-393: No I Northern Virginia ~IA 'WN (Northern Virginia Community College)

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No
~IA
I Northern Virginia
'WN
Community College
Form 125-393
Rev. 03/20
Page 1 of 2
F-1 Student Financial Statement – PPREP Program
Instructions: As a student, it is your responsibility to demonstrate that you will have sufficient financial support available to cover all
educational and living expenses while you are studying at NOVA. You must show a promise of funds and you must provide bank statements to
show that the promised money is presently in a bank.
Please make copies of all financial documents before sending them to NOVA. You will need these copies when you apply for your F-1 visa .
All bank statements must be in English or be a certified English translation that clearly shows the account owner’s name, statement date,
balance and type of currency. (NOVA reserves the right to request clarification or additional information related to bank statements)
Estimated Cost for one Academic Year
(nine months)
Tuition *
Living Expenses (housing, food, etc)
Books and supplies
Total
$9,354
$13,311
$1,800
*
Tuition rates are
subject to
change
without notice.
Credit amounts are determined by ESL requirements at each level with minimum required 12 credits for F1
status based over 2 semesters (academic year).
NOVA is a community college and does not
offer student housing. You will be responsible for making your own living arrangements.
Dependent Expenses: If you will be accompanied
by a spouse and/or child you must add $6,898 per year of support for a spouse and $3,450 for each child.
Section 1: TO B
E COMPLETED BY THE STUDENT: Please
print
your name clearly as it is listed on your passport.
First name
(given na
me)
Middle name Last name (family name)
From where will you get your funds:
Source of Funds Amount
Student
US $
Sponsor(s)
US $
Other
US $
Total* US $
I certify that the information I have provided is a correct statement of my financial support. I understand that if these fun
ds are not available,
NOVA is under no obligation to support me and it is likely that I will be unable to continue my education in
the United States. I understand that,
as an F
-1 student, I must enroll in full-time studies, and I am not permitted to work off-
campus without written approval from the Department of
Homeland Security.
Student’s signature Date
$24,465
Level 4 and 5
Level 5: (
Semester 1: 10 ESL credits + 2 academic credits/Semester 2: 12 academic credits)
Level 4 (Semester 1: 10 ESL credit + 2 academic credits/Semester 2: 10 ESL credits + 2 academic credits)
click to sign
signature
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signature
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3/20
Form 125-390
Page 2 of 2
SPONSOR’S AFFIDAVIT OF SUPPORT
A sponsor may be a parent, family member, or another person who will provide financial support. It is not necessary that a financial sponsor
live in the U.S.
If there is more than one sponsor, please make a copy of this document for each sponsor to complete. One financial sponsor
may provide complete or partial support for the student, but the student’s total financial support must equal or exceed the total estimated
costs (see page 1).
In addition to signing this document, you must provide a bank statement that includes your name, the name of your bank, the statement date,
amount of the available funds and type of currency. The bank statement must be in English, be a certified English translation or clearly show
the information required. The statement must be recent (dated not more than six months before the date classes will begin at NOVA).
This evidence is required to complete an official US government form on which the school official is confirming that financial support is
available. Therefore, Northern Virginia Community College reserves the right to request additional information or clarification.
Section 2: TO BE COMPLETED BY STUDENT’S FINANCIAL SPONSOR
I guarantee that I will be responsible for providing financial support for:
Student’s last name (family name) Student’s first name (given name) Student’s middle name
Amount Promised:
US $
Supporting document: In addition to signing this document, you must provide a bank statement that includes your name, the name of your
bank, the statement date, amount of the available funds and type of currency. The bank statement must be in English, be a certified English
translation or clearly show the information required. The statement must be recent (dated not more than six months before the date classes
will begin at NOVA).
Please read carefully and sign below:
I understand that the document I am signing will be used by the student for the purpose of obtaining F-1 status or an F-1 visa from the U.S.
government or for the purpose of updating the student’s SEVIS record. If I am unable to provide the financial support I have promised, I
understand that NOVA is not obligated to support the above named student. I understand that without my financial support, it is likely that the
student will be unable to continue his/her education in the United States.
I understand that F-1 students are not permitted to work off-campus or provide any services in exchange for financial support. I will not
suggest or require this student to provide any services while in the United States.
Sponsor’s Name (please print):
Email address:
Telephone (with country/area code):
Relationship to the student:
Sponsor’s signature: Date:
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Form 125-393: No I Northern Virginia IA 'WN (Northern Virginia Community College)

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Completed 24 March 2021

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