Affidavit of Free Room and Board
(To be completed by the person providing free room and board to the applicant applying for an I-20)
This affidavit is being submitted on behalf of: ,
Name of Applicant
who will be living with me, free of charge, ,
Name of the Sponsor for Room and Board
at my home located at ,
Street Number and Name
, , ,
City State Zip Code
for the duration of (period of time or end date)
If needed, I can be reached at:
Phone Number(s)
and email:
Affirmation of Oath
I hereby affirm that I own ( )/rent ( ) the above residence and that all the information in this
affidavit is accurate. By signing this form, I agree to not require any services from the student in exchange
for the free room and board.
Proof of address is attached (lease, mortgage, utility bill, ID listing the above address).
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: