BANK AFFIDAVIT FORM FOR INTERNATIONAL STUDENTS
(Please have this form filled out by your bank)
1. Give your name as it appears (or will appear) on your passport. Your passport name and application I-20
must be the same.
Student’s Name: Last/Family______________________________________ First _______________________________
Date of Birth: _____/_____/_____
2. Sponsor/Account holder’s Name (print):
Last/Family: ____________________________________________________ First: _____________________________
3. Bank certification: I certify that the account holder listed above has liquid assets deposited in this bank that meets or
exceeds U.S. $21,572 (Twenty one thousand, five-hundred and seventy two dollars).
Name and Address of bank:
Bank Representative’s Title: _______________________________________________________________________________
Bank Representative’s Signature: ___________________________________________________________________________
Date Account Opened: _____/_____/_____ Amount deposited for past 12 months: ____________________________
Date form Completed by Bank Representative: _____/_____/_____
NOTICE TO STUDENT: If you have more than one sponsor, each sponsor must complete a Bank Affidavit
Form and a Sponsor’s Statement Form.
Mail to: Tarrant County College
1500 Houston St.
Fort Worth, TX 76102-6599
Tarrant County College is an Equal Opportunity Institution that provides educational and employment opportunities on the basis of merit
and without discrimination because of race, color, religion, sex, age, national origin, veteran status or disability.