international financial affidavit form brcc

Blue Ridge Community College
180 W. Campus Drive • Flat Rock, NC 28731
Affidavit of Financial Support for International Applicants
(Please print legibly or use typewriter and please answer all items.)
1.
Name of Sponsor: _______________________Address:____________________
(Street and number)
_________________________________________________________________________________________________
(City)
(State)
(Zip Code if in U.S.)
(Country)
2.
This affidavit is executed in behalf of the following person:
Name of Student:____________________________ Sex:
Male
Female
Date of Birth:_____________________Citizen of (Country)_________________
Marital Status:___________________Relationship to Sponsor:_______________
Presently Resides At:________________________________________________
(Street and Number)
(City)
(State)
(Country)
Name of spouse and children accompanying or following to join student:
Spouse
Sex
DOB
Child
Sex
DOB
Child
Sex
DOB
Child
Sex
DOB
Child
Sex
DOB
Child
Sex
DOB
3.
I make this affidavit for the purpose of assuring Blue Ridge Community College
that the person(s) named in item 2 will not become a public charge in the United
States.
4.
I am willing and able to receive, maintain and support the person(s) named in
item 2. I am ready and willing to deposit a bond, if necessary, to guarantee that
such person(s) will not become a public charge during his or her stay in the
United States.
5.
I understand this affidavit will be binding upon me for the duration of study of the
person(s) named in item 2.
6.
I am employed as, or engaged in the business of __________with_____________
at________________________________________________________________
(Street and Number)
(City)
(State)
I derive an annual income of
I have on deposit in savings banks in the United States or ___________
(Country)
(Zip Code)
$___________
$ ___________
7.
The following other persons are dependent upon me for support: (Place an “X” in
the appropriate column to indicate whether the person named is wholly or
partially dependent upon you for support.)
Name of Person
Wholly
Dependent
Partially
Dependent
Age
Relationship to Me
8.
I have previously submitted affidavit(s) of support for the following person(s).
If none, state “None”.
Name
Date Submitted
__________________________________________________________________
__________________________________________________________________
9.
Please specifically describe what support you intend to provide for the student.
(For example: If you live in the Hendersonville area and are providing room and
board, please state this.) Give many details of the level of support you will be
providing.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
OATH OR AFFIRMATION OF SPONSOR
(Signature must be witnessed by Notary Public,
Attorney, or other Official authorized to administer oaths.)
I swear (affirm) that I know the contents of this affidavit signed by me and the statements
are true and correct.
Signature of Sponsor:______________________________________________________
Subscribed and sworn to (affirmed) before me this _______________day of __________
(year:)________________,at ________________________________________________
My commission expires on _________________________________________________
Signature of Officer Administering Oath:______________________________________
Title:___________________________________________________________________
To complete the financial documentation, this affidavit must be accompanied by an original bank
letter (on bank letterhead stationery) confirming that the sponsor has the financial means to support
the applicant. The bank letter must show at least one year of estimated annual expenses ($16,200-2
semester or $22,475-3 semester) on deposit in an account in the student’s name. It must include a
current exchange rate if the account is not in U.S. dollars. It must be no more than 2 months old.
Original copies of a recent account balance statement should be attached to verify the deposited
funds. Photocopied or faxed documents will not be accepted.