Affidavit of Support

Center for International Education and Global Engagement 2202 W. Anklam Road Tucson, Arizona 85709-0130 USA Telephone: (Country Code 1) (520) 206-6732 Email:: [email protected] Affidavit of Support Each international student seeking admission to Pima Community College (PCC) must complete this form and submit it by the deadline of the student’s intended semester of enrollment. This affidavit will be considered valid for six (6) months from the date of completion. All signatures are required before a student is considered for admission to PCC. Completed affidavits and supplemental documentation must be submitted to the Center for International Education and Global Engagement (CIEGE). Any section left blank, including the signature(s), may delay the processing of your I-20. Please submit the signed form to [email protected] OR West Campus, 2202 W. Anklam Road, Room C157, Tucson AZ, 85709-0130 by mail or in person. 1. Applicant Information Surname (Last): Given Name (First + Middle): Gender: Female Male Date of Birth (MM/DD/YYYY): / / Email address: 2. Estimated Minimum Cost of Attendance (Based on 2019-2020 academic year) International Student Tuition and Fees ................................................................................. $7,656* Health Insurance .................................................................................................................. $1,474* Books and Supplies ...............................................................................................................$1,200 Living Expenses .....................................................................................................................$7,808 Total: ....................................................................................................................................$18,138 Dependents: Add $5,000 for spouse and $3,000 per child * International students must enroll in a minimum of 12 credits per semester. Tuition, fees, health insurance and refunds are subject to change without notice. 3. Student Statement (How will you prove financial responsibility?) Check the appropriate option below. Student’s Personal Funds / Self-Sponsored (Please attach a bank statement. If your bank cannot provide one, please go to Step 4.) I certify that I have the Estimated Minimum Cost of Attendance available for my program of study at Pima Community College. This money is in addition to any travel money needed to return to my country of origin. If I am married and/or will have an accompanying child or children, I certify that I have the additional amounts required for my spouse and/or children. Affidavit of Support 1 of 2 2005AC4W Family / Private Sponsor (Please attach a bank statement. If your bank cannot provide one, please go to Step 4.) I am willing and able to guarantee the financial support of the student in the Estimated Minimum Cost of Attendance available for each program of study at Pima Community College. Name of sponsor: Relationship to the student: Signature of the sponsor: Date: Scholarship / Sponsorship (Please attach an official scholarship letter.) The student agrees to have his/her sponsor submit a separate letter of intent prior to the student’s first semester at Pima Community College. The letter will include the amount, terms, duration authorized and the contact information for billing of tuition and fees. The sponsor will contact the CIEGE regarding the requirements for third-party sponsorship, including the completion of any required tax forms. The student and sponsor understand that billing must be made to PCC through the student’s embassy or other agent within the United States. The student agrees to pay all tuition and fees if the sponsor does not provide funds or if the sponsor pays the student directly. The student understands that his/her course registration may be dropped for nonpayment. Name of scholarship sponsor: 4. Bank Certification If your bank cannot provide a bank statement, please have a bank officer complete the certificate below. It must be completed by a bank officer only and a bank seal/stamp is required. Name on the bank account: Account balance in USD: Date: Bank name and address: Signature of bank officer AND seal/original address stamp: Student’s signature (required): Date: I certify that all of the information I have provided is complete, accurate and true. I understand that any changes that I request must be submitted in writing to the PCC Center for International Education and Global Engagement. Affidavit of Support 2 of 2.

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