a
i •
:,
~
i
'I.
~
..
~•u
•~
UNIVERSITY
of
HAWA1 ' 1•
HILO
•
• •
•
I
I~
I
('
('
INTENT-TO-ENROLL FORM for International Students
ID:
(Your ID is printed on your acceptance letter)
Name:
Last First MI
Address:
Street Number or P.O. Box
City State/Province
Postal / Zip Code Country (if not US)
YES! I accept your offer of admission and will enroll for the
Fall Spring
semester.
No. I will not enroll at this time.
Signature:
Date:
Intent to Enroll Fee Section:
If you are paying the fee you can do so by check or money order drawn from a U.S. Bank or by credit card.
OFFICE USE ONLY:
Please fill in the appropriate information below:
Money Order or Check (attach check or money order drawn from a US Bank and submit form)
Choose
One
Credit Card (complete credit card information below and submit form)
Credit Card Information (complete if paying by credit card):
Cardholder Name: Phone:
Address (Street
Number or P.O. Box)
City State/Province
Postal/Zip Code Country (if not US)
Master Card
Card Number
CVV2 Expiration Date
Visa
Agreement: I agree to pay $60.00 (U.S.) according to the card issuer agreement. By signing the payment authorization
form, I acknowledge that the fee is non-refundable and non-transferable.
Date
Card Holder Signature
If submitting payment by credit card, you may fax the form to: UH Hilo Admissions Office at 1-808-932-7459. If submitting payment by
check drawn on a US account or money order you may mail the form and payment to: UH Hilo Admissions Office, 200 West Kawili
Street, Hilo,, Hawai`i 96720. Cash payments can only be made by visiting the Business Office on campus.
