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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. |
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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. |
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Sponsor Information |
1. |
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I, ______________________________________________, citizen of ______________________________________, |
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sponsor (family name, given name) |
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country/ies |
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and residing at __________________________________________________________________________________ |
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street |
city/state |
country |
postal code |
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___________________________________________________________________________________ |
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telephone number/s |
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email |
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2. |
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I am employed with ______________________________________________________________________________ |
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name of employer |
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employer's telephone number |
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located at _____________________________________________________________________________________ |
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street |
city/state |
country |
postal code |
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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. |
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Certify the following: |
3. |
I have $ (in U.S. dollars) on deposit with:________________________________ |
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name of bank |
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Bank address: ____________________________________________________________________ |
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street |
city/state |
country |
postal code |
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4. |
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Attach bank officer's statement of account history. |
4a. |
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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) . |
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4b. |
I sponsor # ___________ individuals for immigration in addition to this affidavit. |
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Student Support Information |
5. |
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This affidavit is executed on behalf of _______________________________________________________________ |
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student (family name, given name) |
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who was born on _____________________________. S/He is my __________________________________ . |
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month, date, year |
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relationship to sponsor |
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6. |
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I hearby certify that I am willing, able, and do commit to provide_______________________________________________ |
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student (family name, given name) |
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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 _______________________________________________ . |
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month, date, year of when the sponsorship is expected to terminate |
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Room and Board Support Information |
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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. |
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Please print name: ________________________________________________________________ |
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