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Hcc Affidavit Of Financial Support

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HCC ID: ___________________

Affidavit of Financial Support

(For Non-US Citizen/ Non-US Resident Sponsor)

This is to certify that I will assume financial responsibility for the student’s duration of study at Houston

Community College (and dependents, if applicable).

Full Financial Responsibility* [ ]

Tuition and Fee Expenses* [ ]

Living Expenses* [ ]

Dependent Expenses** [ ]

NOTE: *

You must include additional supporting financial documents showing assets in the amount of $22,980 USD

(given this is the estimated cost for a full year of study at HCC). **Additional financial support required: $4,400 USD

per dependent. These figures are subject to change without notification.

STUDENT INFORMATION:

___________________________

Family (Last) Name

First Name

Date of Birth

DEPENDENT INFORMATION:

(Copy of proof of relationship must be submitted in English. Additional

dependents can be added on a separate sheet of paper.)

___________________________

Family (Last) Name

First Name

Date of Birth

___________________________

Country of Birth

Country of Citizenship

Relationship

FINANCIAL SPONSOR INFORMATION:

___________________________

Family (Last) Name

First Name

Date of Birth

___________________________

Relationship to Student

Telephone number

___________________________________________________________________________________________________

Sponsor’s Complete Mailing Address

I acknowledge that the above financial support information is accurate and complete to the

best of my knowledge. I am aware of my financial responsibilities as a financial sponsor to the

student named on this form. I therefore certify that I know the contents of this affidavit signed by

me and that the content is true and correct.

______________________________

_________________________

Financial Sponsor’s Signature

Date of Signature

3100 Main Street, MC 1138, Houston, TX 77002

713.718.8521

713.718.2112

hccs.edu

Rev. 05/2013

Hcc Affidavit Of Financial Support

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