Monroe College, Office of International Admissions 145 Huguenot Street, New Rochelle, NY
P. 914-740-6406, F. 914-813-1266
To be completed by OFF-CAMPUS HOUSING sponsor (Please type or print neatly):
1. I, __________________________________________________ ________________________________________________,
Last Name First Name
residing at _____________________________________________________________________________________
(Street and Number)
____________________________ _____________________________ _________________________ _________________________
(City) (State/Providence) (Zip/Postal code) (Country)
_________________________________ __________________________________ ___________________________________________
(Home Phone Number) (Cell) Email
Execute this affidavit on behalf of the following person:
______________ _________________________________ ________ ________ _____________________
(Student’s Name: last, first) (Sex) Date of Birth (Month/Day/Year)
___________________________________ ________________________ _____________________________________
(Citizen of - Country) (Marital Status) Sponsor’s Relationship to Student)
(HOME COUNTRY ADDRESS-Street and Number) (City) (State/Providence) (Zip code if in U.S.) (Country)
In support of this affidavit, I certify and state:
2. I assure Monroe College and the United States government that the person named in item #1 will not become a public charge in the United
3. I will provide room and board at NO COST to the student at my residence while studying at Monroe.
4. My housing contributions will extend to each year of the student’s study at Monroe College until completion of his/her degree.
5. That I am gainfully employed by________________________________________________ _______________________________________
(Name of Business) (Position/Job Title)
(Street and Number)(City) (State/Providence) (ZipCode if in US) (Country)
I affirm that I know the contents of this affidavit signed by me and the statements are true and correct.
Signature of Sponsor _______________________________________________________________________
Date (Month/Day/Year)
REV. 11/22/11
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