Fillable Supplemental Page A Dependent Information Form (College of Alameda)

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Supplemental Page A Dependent Information Form (College of Alameda)

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STUDENT NAME: Date of Birth:
MONTH, DAY, YEAR
DEPENDENT INFORMATION
Number of
Dependents
Dependent Listing
Amount
Total
1
1
st
Dependent
$5,000 USD
$5,000 USD
2
2
nd
Dependent
$2,500 USD
$7,500 USD
3
3
rd
Dependent
$2,500 USD
$10,000 USD
4
4
th
Dependent
$2,500 USD
$12,500 USD
5
5
th
Dependent
$2,500 USD
$15,500 USD
Please list any dependents that will be applying for F-2 Status. Dependents may only be your spouse and/or
children and each have their Passport Bio Page submitted. Proof of marriage and/or dependents may also be
requested. Dependents will be required to apply for an F-2 visa in order to enter the United States.
1) Spouse Name: Date of Birth (mm/dd/yy):
City, Country: Country of Citizenship:
2) Child Name: Date of Birth (mm/dd/yy):
City, Country: Country of Citizenship:
3) Child Name: Date of Birth (mm/dd/yy):
City, Country: Country of Citizenship:
4) Child Name: Date of Birth (mm/dd/yy):
City, Country: Country of Citizenship:
5) Child Name: Date of Birth (mm/dd/yy):
City, Country: Country of Citizenship:
I have a total of
Dependents;
In addition, the number of dependents will increase the amount that needs to be demonstrated on the bank statement.
Please follow this table and add the amount to the total amount on the Section H. Financial Information (page 4). The
total amount is non-negotiable. Please submit this page with your International Student Application
Add Total (table below) to $21,440 =
Supplemental Page A – Dependent Information Form
Return Form with Application or by fax (510) 465-3257 or email to international@peralta.edu
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Supplemental Page A Dependent Information Form (College of Alameda)

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Completed 3 September 2020

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