UNIVERSITY OF HAWAI`I AT HILO ▪ GRADUATE DIVISION
Admissions Office • 200 Kawili St. • Hilo, HI 96720 Tel: (808) 932-7446, (800) 897-4456 Fax: (808) 932-7459 • e-mail: uhhadm@hawaii.edu • Web: www.hilo.hawaii.edu
CONFIDENTIAL FINANCIAL STATEMENT FORM FOR INTERNATIONAL APPLICANTS
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.
Estimated Student Budgets : All tuition and fee charges at the University of Hawai'i campuses are subject to change in accordance with State law and/or action
by the Board of Regents or university administration. (See Financial Aid
for the Estimated Annual Student Budgets for Non-Resident Students for the academic
year you plan to enter. Please note that Health Insurance is also required so you must add an additional $2500 to your budget.)
Type or print clearly. Where not applicable, write "N/A"
Personal funds available
for first year of study (US$)
I agree to be financially responsible for my expenses at the University of Hawai`i at Hilo for the duration of my study and I will notify the
Graduate Admissions Office of any change in my financial circumstances. Confirmation of the first year of support is provided as
financial evidence. I certify the information provided on this form is correct and complete to the best of my knowledge.
BANK VERIFICATION This is to certify that the applicant 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.
Program:
Fall
Spring
Year
Male
Female
A.
Semester
Family/
Last Name
e-mail address
Current Telephone
Street
Permanent Foreign Address
Date of Birth
MM/DD/YY
Place of Birth
City and Country
Country of
Citizenship
Use names as listed on passport:
Country Issuing
Passport
Country of Legal
Permanent Residency
Occupation
Name of
Employer
If employed by home government, indicate whether city, provincial or central government.
Signature of Applicant
Date
MM/DD/YY
Name of
Account
Holder
Type of
Account
Date
Opened
(MM/YY)
Name &
Address of Bank
Signature of
Bank Official
Date
Bank Seal or Stamp
Page 1 of 3
Gender
First
Name
Middle
Name
City
State/
County
Postal
Code
Name of
Bank Official
Title
International Students (Not Pacific Island Exemption)
Pacific Island Exemption: Futuna, Kiribati, Nauru, New Caledonia, Niue, Solomon Islands, Tokelau,
Tonga, Tuvalu, Vanuatu, Wallis
