Affidavit of Support
 
 
This form must be completed by the person (sponsor) who will provide the student with full or partial support and/or room and board duing the student's course of study at the City University of New York.
 
Instructions: Complete items 1 through 6 if you are a sponsor providing financial support; Complete items 1 and 7 if you are a sponsor providing room and/or board.
 
Sponsor Information
1.
 
I, ______________________________________________, citizen of ______________________________________,
sponsor (family name, given name) country/ies  
and residing at __________________________________________________________________________________
street city/state country postal code  
___________________________________________________________________________________
telephone number/s email  
2.
I am employed with ______________________________________________________________________________
name of employer employer's telephone number
located at _____________________________________________________________________________________
street city/state country postal code
I receive an annual income of $ (in U.S. dollars) from this employment.*
*Attach a current salary confirmation statement written by that employer or verification of annual income for self-employed or retired individuals. The employer statement or verification of annual income must be written in English or come with a certified translation.
 
Certify the following:
3.
I have $ (in U.S. dollars) on deposit with:________________________________
name of bank
Bank address: ____________________________________________________________________
street city/state country postal code
4.
    Attach bank officer's statement of account history.
4a.  
I currently support # ___________ persons (number of people including myself).
Our total annual income is $ (in U.S. dollars).
Our total family expenses are $ (in U.S. dollars) .
             
4b. I sponsor # ___________ individuals for immigration in addition to this affidavit.
 
Student Support Information
5.
This affidavit is executed on behalf of _______________________________________________________________
    student (family name, given name)
 
who was born on _____________________________. S/He is my __________________________________ .
    month, date, year   relationship to sponsor  
 
 
 
 
 
 
6.
 
 
I hearby certify that I am willing, able, and do commit to provide_______________________________________________
            student (family name, given name)    
with an annual amount of $ (in U.S. dollars) for his/her tuitions, fees
and/or living expenses during the entire program of study at the
CUNY/ELI until _______________________________________________ .
    month, date, year of when the sponsorship is expected to terminate
 
Room and Board Support Information
7.
 
 
I hearby certify that I am willing to provide ____________________________________________________ with:
student (family name, given name)        
Room only in my home at the address: valued at $7,500.*
Full room in my home at the address above and board: valued at $10,000.*
*Note that this value cannot be included in any amount of support being provided in #6 above. Attach a copy of your lease or deed or copy of a statement from your landlord.
 
 
 
Signature of sponsor: ____________________________________ Date: _____________________
By signing my name to this affidavit, I certify that the information above is a correct statement of my agreement to sponsor the student herein named.
 
Please print name: ________________________________________________________________