Fillable Intl Sup Form (University of Hawaii at Hilo)

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Intl Sup Form (University of Hawaii at Hilo)

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UNIVERSITY OF HAWAI`I AT HILO ▪ Supplementary Information Form for International Students
Admissions Office • 200 West Kawili St. • Hilo, HI 96720-4091 USA Tel: (808) 932-7446, Fax: (808) 932-7459 • e-mail: uhhadm@hawaii.edu • Web: www.hilo.hawaii.edu
CONFIDENTIAL FINANCIAL STATEMENT FORM FOR INTERNATIONAL APPLICANTS (SECTION C only)
INSTRUCTIONS: Attach official bank statement(s) if your bank will not complete the BANK VERIFICATION section. If sponsored by a government
or private organization, a signed award letter is required. Bank statements may not be more than 90 days old. Mail-in completed form and
documentation to the address above, or submit by fax or e-mail attachment.
Type or print clearly. Where not applicable, write "N/A"
Family/
Last Name
Use names as listed on passport:
First
Name
Middle
Name
SECTION A - EDUCATIONAL INFORMATION
1. List schools attended, and include the one you are now attending.
Name of Institution (do not use initials) Location
From
Month/Yr.
To
Month/Yr.
Name of
Diploma/Certificate
Date
Received
Month/Yr.
Primary schools (no transcripts required):
Secondary or middle schools (no transcripts required):
2. What is your native language? 3. What is the language spoken in your home?
4. How many years have you studied in a school where English is the language of instruction?
In secondary or middle school from (month) / (year)
/ (year)In university or college from (month)
5. If you have taken/ will take the Test of English as a Foreign Language (TOEFL) specify test date:
MM/DD/YY
6. Why did you select the University of Hawai`i at Hilo?
7. Provide additional information that may be helpful in evaluating your application, such as employment, talents, skills,
fellowships or scholarships.
SECTION B - APPLICANT'S CERTIFICATION
I certify that the information I have given on this form is complete and correct to the best of my knowledge and that I have not attended any
educational institutions other than those listed. I understand that application materials will become the property of the University of Hawai`i at
Hilo and will not be returned to me nor be available for distribution.
Printed Name:
Signature (By entering your last name on this line,
you agree that it is the same as your signature):
Date: (MM/DD/YY)
SECTION C - CONFIDENTIAL FINANCIAL INFORMATION
Applicants requiring an I-20 or DS-2019 for the F-1 or J-1 (student) visa/status must complete this section. Non-immigrant student visa
holders are required to document sufficient funds to provide for their academic studies in the United States.
Page 2 of 2
Name of school that issued your last I-20 or DS-2019:
II. Name of sponsor:
Phone:
Signature of
Sponsor
Signature of
Bank Official
Bank Seal or Stamp
Date
Opened
(MM/YY)
Type of
Account
Name &
Address of Bank
Name of
Account
Holder
III. BANK VERIFICATION This is to certify that the listed above is financially capable of the monetary
support indicated above and if the funds are outside the U.S.A., there are no government restrictions regarding the release of the
funds. This certification is offered with no responsibility on the part of this bank or financial agency.
Date
Date
Title
Name of
Bank Official
Middle
Name
First
Name
I. Family/Last Name
Date of
Birth:
Permanent
address in
home country:
e-mail
address:
If yes, type of visa:
Do you plan to enter the U.S.
from abroad?
Do you currently
hold a U.S. visa?
No Yes No Yes
If in the U.S. give your SEVIS I.D. number:
If you plan to bring dependents, list their names and required information in the spaces below. Provide evidence that approximately $4,000 per
year/per dependent is available above the amount required for yourself:
Name Birth Date Country of Birth
Country of
Citizenship
Relationship Gender
Address:
Relationship to student: Yearly amount of support in U.S. $:
By signing this affidavit of support, I (or my organization) agree to be financially responsible for the student indicated above by way of tuition,
fees, living and any other relevant expenses for the duration of this student's enrollment at the University of Hawai`i at Hilo (or for years).
applicant
sponsor
(check one)
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Intl Sup Form (University of Hawaii at Hilo)

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Completed 24 July 2020

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