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Fillable Printable 2014-2015 Financial Affidavit - Iowa Western Community College

Fillable Printable 2014-2015 Financial Affidavit - Iowa Western Community College

2014-2015 Financial Affidavit - Iowa Western Community College

2014-2015 Financial Affidavit - Iowa Western Community College

Iowa Western Community College
2700 College Rd. Council Bluffs, IA 51503
admissions@iwcc.edu | 800.432.5852 or 712.325.3277 | iwcc.edu
2014-2015 Financial Affidavit
All applicants must submit a completed financial affidavit and supporting bank documents before
the college can issue a Form I-20, Certificate of Eligibility. Read the following instructions carefully
before completing and submitting this form. Photocopies, faxes, or on-line computer printouts of
bank statements are not acceptable unless sent directly from your financial institute.
Instructions
Supporting bank documents must be signed and stamped by a bank official and dated within six
months (180 days) of the day your application is submitted.
Supporting bank documents must be original and include official English translations.
An International Student may have more than one financial sponsor.
An International student in the U.S. on an I-20 may not serve as a sponsor for another student.
Iowa Western Community College (IWCC) reserves the right to require additional financial
documentation from applicants.
All documents provided in support of the financial affidavit become the property of IWCC and
cannot be returned.
Estimated Academic Year Expenses*
Tuition & Fees** $7,896
Books & Supplies $1,164
Room & Board $7,820
Transportation $1,808
Personal Expenses $1,886
Health Insurance $750
Total Expenses*** $21,324
**Based on 15 credit hours per semester for the academic year (Aug - May).
***The total amount of funds required is represented in U.S. Dollars
Dependant Expenses*
The following amounts should be added to the above totals when a spouse and/or children are
accompanying the student to the United States.
Spouse $3,000
Each Dependant Child $1,500
Optional Expenses*
Summer session tuition is estimated $251.00 per credit hour. Summer living expenses vary.
*All figures are estimates and subject to change without notice.
Iowa Western
2700 College Rd. Council Bluffs, IA 51503
admissions@iwcc.edu | 800.432.5852 or 712.325.3277 | iwcc.edu
Section 1. Student Information
Student’s Name: ______________________________________________________________________________
Last/Family First Middle
List names of spouse and/or children who will accompany you to the United States.
Family Name Given Name Date of Birth Country of Birth Country of Citizenship Relationship
1.
2.
3.
Section 2. Statement of Financial Support
Financial support from all sources must equal $21,324
Please list the sources and amounts (in U.S. dollars) of your financial support for each year during your studies at IWCC:
Student’s Personal Funds ……………………………………………………………………………………………………………………. $____________
Indicate amount of support, sign Section 3A, and provide a supporting bank document.
Funds from Family or Others ………………………………………………………………………………………………………………….$____________
Name of Sponsor ________________________________________ Relationship to Student ________________________
Indicate amount of support, have your sponsor(s) sign Section 3B, and provide a supporting bank document.
Funds from Another Source (scholarships from government agency, private foundation employer, or other agency)……………. $____________
Name of Agency ________________________________________
Indicate amount and enclose a signed letter from the agency which specifies amount.
Funds from IWCC ……………………………………………………………………………………………………………………………...$____________
TOTAL (MUST EQUAL $21,324)……………………………………………………………………………………………………………. $____________
Section 3. Verification of Financial Support
A. I, __________________________________________ , certify that the information given on this form is complete and accurate to the best
(Student’s Name)
of my knowledge. I am fully aware that any false or misleading statements will result in an automatic denial of admission.
__________________________________________________________ _____________________________________________________
Student’s Signature (REQUIRED) Month/Day/Year
B. This is to certify that I (we) the undersigned have agreed to provide the funds indicated above to the student for the purpose of full-time
study at Iowa Western Community College, and that I (we) are submitting bank documents indicating the availability of these funds. I (we)
agree to maintain financial support in covering tuition and living expenses.
__________________________________________________________ _____________________________________________________
Sponsor’s Signature Month/Day/Year Relationship to Student
__________________________________________________________ _____________________________________________________
Address City, Country Postal Code Telephone Number
__________________________________________________________ _____________________________________________________
Sponsor’s Signature Month/Day/Year Relationship to Student
__________________________________________________________ _____________________________________________________
Address City, Country Postal Code Telephone Number
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