Affidavit of Free Room and Board
The Affidavit of Free Room and Board can only be completed and duly signed by the sponsor/person who has completed the Affidavit of Support (USCIS Form I-134) for the
student applying for a SEVIS I-20. The Affidavit of Support (USCIS Form I-134) is a legally enforceable contract.The sponsor/person should be at least 18 years old and a U.S.
Citizen or a Permanent Resident.
Complete this duly notarized form (original only, copies will not be accepted) and return to MCC International Student Affairs, Great Path, MS #12, P.O. Box 1046, Manchester,
CT 06045-1046 or drop off at the International Student Affairs office, SSC L156.
REQUIRED
This affidavit is being submitted on behalf of
Applicant First Name MI Applicant Last Name
Banner ID
who is living with me free of charge
Sponsor Name
at my home located at
Sponsor Address Apt. #
City State Zip
for the duration of
Period of time or end date
If needed, I can be reached at:
Sponsor Phone Sponsor Cell Phone Sponsor Email
AFFIRMATION OF OATH
I hereby affirm that I
n
own
n
rent the above residence and that all of the information in this affidavit is accurate. Proof of address is attached (lease, mortgage,
utility bill, or ID listing the above address).
By signing this form, I agree to not require any services from the student in exchange for the free room and board.
Signature of Sponsor
Sworn and subscribed before me on this
day of , in the year .
Signature of Officer Administering the Oath (Notary Public)
Official Seal of Notary Public
February 2020/PR
