Fillable Printable Affidavit of Financial Support Form - Houston Community College System

Affidavit of Financial Support Form - Houston Community College System

3100 Main Street, MC 1138, Hous ton, TX 7700 2 T 713.718. 8521 F 713.718. 2112 W hccs.edu

Rev. 05/2013

This is to certify that I will assume financial responsibility for the studen t’s durat ion of study at Houston

Comm un ity Colleg e (and depe nd ents, if ap pl ic able).

Full Financial Responsibility* [ ] Tuition and Fee Expenses* [ ] Living Expenses* [ ] Dependent Expenses** [ ]

NOTE: *

You must include additional supporting financial documents showing assets in the amount of $22,980 USD

(given this is the estimated cost for a full year of study at HCC). **Additional financial support required: $4,400 USD

per dependent. These figures are subject to change without notification.

STUDEN T INF O RMATION :

___________________________ _______________ ____________ ___________________________

Family (Last) Name First Name Dat e o f Birth

DEPENDENT INFORMATION:

(Copy of proof of relationship must be submitted in English. Additional

dependents can be added on a separate sheet of paper.)

___________________________ ___________________________ ___________________________

Family (Last) Name First Name Date of Birth

___________________________ ___________________________ ___________________________

Country of Birth Country of Citizenship Relationship

FINANCIAL SPONS OR INFORMATION:

___________________________ ___________________________ ___________________________

Family (Last) Name First N a me Date of Birth

___________________________ ___________________________ ___________________________

Relationsh ip to St ud ent Email Telephon e num ber

___________________________________________________________________________________________________

Sponsor’s Complete Mailing Address

I acknowledge that t h e above financ ial support inform ation is ac curate and com plete to t he

best of my knowledge. I am aw are of my financial res po n sibilitie s as a f inancial sponsor to t he

student named on this form. I therefore certify that I know the contents of this affidavit signed by

me and that the content is true and correct.

______________________________ _________________________

Financial Sponsor’s Signature Date of Signature

Affi da vi t of Financial Support

(For Non-US Citize n/ Non-US Resident Sponsor)

HCC ID: ___________________