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International Student Financial Affidavit Form

1.  You must certify that you have at least fifteen thousand, four hundred and two (U.S. $15,402) available to you to pay all expenses for your first academic year (two semesters) at the college, exclusive of travel expenses.
   
2.  Because of the many INS restrictions regarding the eligibility of F-1 students to work, you should not expect employment. 
    
If you are a married student and plan to bring your spouse and children, a proportionately large amount must be certified, on the basis of at least an additional three thousand, two hundred dollars ($3,200) per year, for your spouse and two thousand, one hundred dollars ($2,100) for each child. Spouses of F-1 visa holders are not permitted to work under any circumstances.
   
3.  To certify the required amount, you must complete and sign the enclosed form and you must have a bank official certify all financial sources on page three, or provide a separate certified bank statement of your financial resources. 
    
You are also likely to need this documentation to prove to the United States Consular officials that you have sufficient funds. We suggest that you make copies of all documents for this purpose.
   
4.  Please note: A form I-20 A-B cannot be issued to you until you have been admitted to the college and have completed this form to our satisfaction and returned it to this office. 

 
Please check all that apply to you:
____  I plan to come alone.  
____  I plan to bring dependents. Please list:  

_______________________________________

_______________________________________ 

_______________________________________ 
 
____  I plan to have my dependents come later.
____  I plan to attend Clinton/Muscatine/Scott    
          Community College for less than one year.
____  I plan to attend Clinton/Muscatine/Scott
          Community College for  ____  years.
 
I,  _____________________________,  certify that the total amount of money that I have available for my first academic year of study at Clinton/Muscatine/Scott Community College (including money for spouse and children if applicable) is  $ ________.  Further, I certify that the above financial figures are correct and that I shall notify the college of any changes in my financial resources.
 
Student's signature 

_____________________________________________

Student's name  (please print) 

_____________________________________________

Date  _________________ 
  
 

(Amounts in US Dollars)
 
Personal or Family

Bank name:  __________________________________ 

1st year  $ _________  2nd year $ _________

Address:  ____________________________________________
  
 
Parents or Spouses

Name:  ______________________________________ 

1st year  $ _________  2nd year $ _________

Address:  ____________________________________________
 
Name:  ______________________________________ 

1st year  $ _________  2nd year $ _________

Address:  ____________________________________________
  
 
Your Government Help  (If any)

Agency Name:  ________________________________ 

1st year  $ _________  2nd year $ _________

Address:  _____________________________________________
Contact Name:  ________________________________
Include a copy of the letter authorizing you to receive money and the amount. 
  
Other

Name:  ______________________________________

1st year  $ _________  2nd year $ _________

Address:  _____________________________________________
Contact Name:  ________________________________

Kind of Help:  __________________________________

Include a signed affidavit from the person authorizing the financial help and the amount. 

------------------------------------------------------------------------
 

Certification

This is to certify that I have read the information given by the applicant on this form, that is true and accurate, and that the funds are available.
 
Bank official's signature  _____________________________________________
Bank official's name  (printed):  _____________________________________________
Title:  ________________________________________
Name of Bank:  ________________________________

Bank Address:  ________________________________

Date:  __________________
 
This is to certify that I have read the information furnished by the applicant on this form, that it is true and accurate, and that the funds are available and will be provided as specified.
 
Sponsor's signature  _____________________________________________
Sponsor's name  (printed):  _____________________________________________
Relationship of Sponsor to Applicant:  _____________________________________________
Address:  _____________________________________
Date:  _________________
 
 
Last Modified 12/23/2003

Click on this link for a printable version of this form.

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