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PASADENA
CITY
COLLEGE
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INTERNATIONAL STUDENT CENTER
SPONSOR AFFIDAVIT FORM
Please type and complete the form.
You are required to attach a current bank statement or letter that indicates an available balance for one year of study at PCC,
which is $25,732 (USD). Documents must be in English or accompany an English translation and be dated within 3 months at
the time of application. These funds must be from a checking, savings, or certificates of deposit. Stocks or investment will
not be considered. Please add an additional $5,000 for spouse or $3,000 for each dependent child.
Student Information
Student Name ______________________________________________________________ Gender Male Female
Family Name First Name Middle Name
Date of Birth ______________________ Country of Citizenship _________________ Country of Birth ________________________
Month/Day/Year
Telephone Number ________________________________________________ FAX Number _______________________________
Email Address _______________________________________________________________________________________________
Home Address _______________________________________________________________________________________________
Number & Street City State/Province Country Postal Code
Sponsor Information
Must be account holder’s name as written on the bank statement/letter
Mr. Ms. ______________________________________________________________________________________________
Last Name First Name Middle Name
Relationship to the applicant ________________________________________Country of Citizenship __________________________
Current Mailing Address
________________________________________________________________________________________________________________
Number & Street City State/Province Country Postal Code
Telephone Number ________________________________Email Address _______________________________________________
I, __________________________ certify that this affidavit is made by me for the purpose of assuring Pasadena
Please print or type your full name
City College that I will take financial responsibility, including but not limited to educational 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 student.
I certify that all information on 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.
Date____________________________
Sponsor’s Signature Month/Date/Year
Pasadena City College • International Student Center
1570 East Colorado Blvd. D-204 • Pasadena, CA 91106-2003
Tel: (626) 585-7808 • Fax: (626) 585-3268 • iso@pasadena.edu • www.pasadena.edu/international
Revised 10/21/2019
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