Student's Name
University of Hawai'i at Hilo
Academic Advisor's
UH ID Number: Major:
Section 2: To be completed by the Student's Academic Advisor
This student's period of allowable time to study in the U.S. will end on the date listed above. He/she is requesting
an extension of time to complete his/her degree program at UH Hilo. To comply with Federal Department of
Homeland Security regulations, the UH Hilo International Student Services office needs to know if you support
the student's request for an extension. Please complete this form and have the student return it to:
Jim Mellon, Director
International Student Services and Intercultural Education
Division of Student Affairs
If you have any questions, please contact Jim Mellon at 974-7313 or mellon@hawaii.edu. Thank you for your
assistance.
I anticipate that this student will complete all requirements for the current program of study by:
This student has not yet completed the current program of study due to delays caused by
(please check all reasons which apply):
requirement to take English-as-a-second language classes prior to beginning other coursework
a change in research topic
credits that did not transfer and/or apply to the student's program upon transfer to UH Hilo
Other (please explain):
I therefore recommend that this student be allowed additional time to complete his/her studies.
Present Completion Date on I-20 (see line 5 on your I-20):
Section 1: To be completed by the Student
Recommendation for Extension of Time for an International Student's Program of Study
unexpected research problems
Fall Spring Summer
Year:
a change in major
Advisor's Signature:
Name:
Department:
Date:
