Statement of Support

If the applicant does not have income or cannot provide documentation showing how they maintain themselves, this form may be used as documentation. This form must be completed and signed by the person who provides support; the applicant should not fill this form.

* Name of person providing support

* Print applicant name

* Applicant street, city, state & zip code

* I have provided support since

* My relation to the applicant is

The type of support that I provide is (check all that apply):

Room

Food, clothes

Rent, mortgage

Utilities (water, electricity, gas, etc.)

Cash $ per month

Other (Explain)

You can contact me at the following number to verify such information:

* Supporter signature

* Date