Severe Economic Hardship Request Form (Page 5 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

SPONSOR’S AFFIDAVIT OF SEVERE ECONOMIC HARDSHIP

INSTRUCTIONS FOR COMPLETING THE AFFIDAVIT:

Describe the unexpected circumstances that have caused you to reduce or stop the financial

support previously committed to the student.

Attach documentary evidence supporting the above circumstances.

State the amount you intend and are able to give to the student.

Sign this affidavit in the presence of a notary public in the U.S. or other licensed official in your

country. The notary public or official must sign and put the official seal on the affidavit.

The affidavit and documentary evidence must be in or officially translated into English.

SPONSOR’S STATEMENT OF UNFORESEEN CIRCUMSTANCES CAUSING STUDENT’S FINANCIAL

SUPPORT TO BE REDUCED OR STOPPED

_________________________________________________________________________________________________________________________

AFFIRMATION OR OATH

I hereby affirm that I know the contents of this affidavit and that the above statements are true and

correct.

Signature of sponsor_____________________________________________________________________________________

Sworn and subscribed before me this __________ day of __________________ in the year ________________

Signature of Officer Administering Oath ___________________________________

OFFICIAL SEAL HERE

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 5