Fillable Printable Affidavit of Support Form – Academic
Fillable Printable Affidavit of Support Form – Academic
Affidavit of Support Form – Academic
2016-2017 Affidavit of Support Form – Academic 1 of 2
2016-2017 Afdavit of Support Form – Academic
This form is to be completed by an international student seeking admission to Pima Community College. This affidavit will
be considered valid for six (6) months from date of completion. This affidavit must be completed and submitted by the
deadline of your intended semester of enrollment. This form must contain all of the appropriate signatures before a student is
considered for admission to Pima Community College.
Name of student (as stated on passport):
Last (family/sur name) First (given name) Middle
Gender Female Male Date of Birth:
MM/DD/YYYY
A minimum of $17,720.00 in U.S. dollars per academic year must be guaranteed. The applicant must have an additional
$5,000 for the accompanying spouse, and $3,000 for each accompanying child. Please provide appropriate bank
certification where indicated. If separate statements from the bank and sponsor are submitted, each must be original.
Monetary amounts must be stated in U.S. dollars.
Check the option you plan to use and complete the appropriate section.
PERSONAL SAVINGS of APPLICANT / SELF SPONSORED
I certify that through my account with the institution listed below, I have the minimum required $17,720.00 U.S. dollars
available for each academic year 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.
Signature of applicant: Date:
Bank Certication: The above-named applicant has on deposit in this institution sufficient funds to cover the amount stated
above. If this bank certification is not provided, you must submit separate, original bank statements.
Date:
Signature of bank officer and seal/original address stamp
Printed name and address of bank:
PRIVATE SPONSOR ( e.g., family member)
I am willing and able to guarantee the financial support of the applicant in the minimum amount of $17,720.00 U.S. dollars
available for each academic year of study at Pima Community College. I am NOT a nonimmigrant student and I do not hold
any other temporary visa in the United States.
My relationship to the applicant is:
Signature of sponsor: Date:
Printed name:
Address: Telephone:
Bank Certication: The above-named private sponsor has on deposit in this institution sufficient funds to cover the amount
stated above. If this bank certification is not provided, you must submit separate, original bank statements.
Date:
Signature of bank officer and seal/original address stamp
Printed name and address of bank:
1604AB1W
Center for International Education
and Global Engagement
2202 W. Anklam Road
Tucson, Arizona 85709-0130 USA
Telephone (520) 206-6732
2016-2017 Affidavit of Support Form – Academic 2 of 2
SCHOLARSHIP / SPONSORSHIP (e.g., government)
Name of scholarship sponsor:
Sponsorship certification: I agree to have my sponsor submit a separate letter of intent prior to my 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. My sponsor also will contact the Center for International Education and Global Engagement regarding the
requirements for third-party sponsorship, including the completion of any required tax forms. I understand that billing must be
made through my embassy or other agent within the United States to Pima Community College. I agree to pay all tuition and
fees if my sponsor does not provide funds or if my sponsor pays me directly. I understand that my course registration may be
dropped for nonpayment.
Signature of applicant (required): Date:
Estimated Minimum Cost of Attendance
Academic Year 2016-2017
(Fall & Spring)
International Student Tuition and Fees (12 credits minimum) $7,362*
Health Insurance $1,355*
Books and Supplies $1,200
Living Expenses $7,803
Total $17,720
Dependents: Add $5,000 for spouse and $3,000 per child.
*Tuition, fees, health insurance and refunds are subject to change without notice.
I certify that all information provided is complete, accurate and true. I also understand that any changes must be submitted in
writing and sent to the PCC Center for International Education and Global Engagement.
Signature of applicant (required): Date:
Email address: Telephone:
Return form to: Pima Community College
Center for International Education and Global Engagement
2202 West Anklam Road
Tucson, Arizona 85709-0130 USA
Telephone: (520) 206-6732
