Severe Economic Hardship Request Form (Page 3 of 5) in pdf

International Student Services

Borough of Manhattan Community College

199 Chambers Street

The City University of New York

New York, NY 10007-1097

Admissions Office Room S-300

212-220-1265

SEVERE ECONOMIC HARDSHIP REQUEST FORM

Name: ____________________________________________________________

Today’s Date: ___________________

(Print) Last

First

Local Address____________________________________________________________________________________________

Phone_______________________________________

BMCC ID #_______________________________________

Major________________________________________

Passport Expires: _______________________________

I have been in F status and have attended school fulltime for at least one academic year and I am

requesting offcampus employment authorization due to severe financial difficulties caused by

the unforseen circumstances beyond my control which I have explained below and on the reverse

side:

EXPLANATION OF FINANCIAL CIRCUMSTANCES BEYOND MY CONTROL:

My financial severe economic difficulties are caused by the circumstances checked off and explained

below and on the other side of this sheet:

Substantial fluctuations in currency or exchange rates

A__________ % increase in tuition since I arrived in the U.S. on_______________ (date)

A__________ % increase in living costs since I arrived in the U.S. on_______________ date)

An unexpected change in the financial ability of my sponsor. A sworn affidavit from my sponsor is

attached.

Loss of on‐campus employment.

Other:

_________________________________________________________________________________________________________________

G:INTERNATIONALISSO FORMS - INFORMATIONAL DOCS - REPORTS 04-25-02ISSO FORMS - INFORMATIONAL

DOCS - REPORTS 04-25-02ISSO SEVERE ECONOMIC HARDSHIP EMPLOYMENT FORM 03-12-12.doc

Severe Economic Hardship Request Form Page 3