2014-2015 Financial Affidavit - Iowa Western Community College

Iowa Western
2700 College Rd. Council Bluffs, IA 51503
[email protected]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
Page 2/2
Free Download

2014-2015 Financial Affidavit - Iowa Western Community College PDF

Favor this template? Just fancy it by voting!
  •  
  •  
  •  
  •  
  •  
(0 Votes)
0.0
Related Forms
  •  
  •  
  •  
  •  
  •  
3 Page(s) | 1092 Views | 1 Downloads
  •  
  •  
  •  
  •  
  •  
42 Page(s) | 5837 Views | 3 Downloads
  •  
  •  
  •  
  •  
  •  
2 Page(s) | 1127 Views | 5 Downloads
  •  
  •  
  •  
  •  
  •  
3 Page(s) | 1093 Views | 3 Downloads