University of Hawai'i at Hilo
Request for Signature on I-20 Form for Travel
If you are leaving the U.S. and returning to UH Hilo, you need to get the signature of the UH Hilo International Student Services
Director on your I-20 Form before you leave. The signature certifies that you have been maintaining proper F-1 student visa
status. Please submit this form at least one week in advance of your departure from Hilo. Please attach your most recent I-20.
Student ID Number:
First
Name:
Last
Address in Hawai'i
City
State Zip Code
Email Address:
Complete Studies Date (see your I-20 form item #5):
Local Telephone Number:
Major:
Country of Citizenship:
Passport Expiration Date:
Visa Expiration Date:
Expected Graduation Date:
TRAVEL INFORMATION
Earliest Possible Date of Departure from Hilo:
Latest Possible Date of Return to the US:
If a spouse or children are traveling, please provide names:
Spouse: Children:
For Office use only- Do not fill out the section below.
CUM GPA: Current Credit Hours Attempted:
Completed by: Date:
Check local address and update if necessary in: Check major change:
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SEVIS
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SEVIS
Today's Date:
Program End Date (see your I - 20)
