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: _____/_____/_____ Affix Stamp Or Seal Here 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 International Admissions 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.
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