Fillable UH Hilo CONFIDENTIAL FINANCIAL STATEMENT FORM INTERNATIONAL APPLICANTS

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UH Hilo CONFIDENTIAL FINANCIAL STATEMENT FORM INTERNATIONAL APPLICANTS

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UNIVERSITY OF HAWAI‘I HILO ▪Supplementary Information Form for International Students
Admissions Office • 200 West Kāwili 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"
Use names as listed on passport:
Family/ First Middle
Last Name Name 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)
In university or college from (month) / (year)
MM/DD/YY
5. If you have taken/ will take the Test of English as a Foreign Language (TOEFL) specify test date:
6. Why did you select the University of Hawai‘i 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
Hilo and will not be returned to me nor be available for distribution.
Printed Name:
Signature
(By entering your last name on this line,
Date: (MM/DD/YY)
you agree that it is the same as your signature):
click to sign
signature
click to edit
• • • •
-
•
SECTION C - CONFIDENTIAL F
INANCIAL 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.
I. Family/Last Name
First Middle
Name Name
Date of
Permanent
Birth:
address in
home country:
e-mail
address:
Do you plan to enter the U.S.
No Yes
Do you currently
No Yes
If yes, type of visa:
from abroad? hold a U.S. visa?
Name of school that issued your last I-20 or DS-2019:
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
II. Name of sponsor:
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 Hilo (or for
______ years).
Signature of
Sponsor Date
(check one)
III.
BANK VERIFICATION T
his is to certify that the sponsor
applicant
listed above is financially capable of the monetary
support i
ndicated 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.
Name of
Type of
Date
Account
Account
Opened
Holder (MM/YY)
Name &
Address of Bank
Name of
Bank Official
Title
Signature of
Bank Official
Date
Bank Seal or Stamp
Page 2 of 2
Phone:
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UH Hilo CONFIDENTIAL FINANCIAL STATEMENT FORM INTERNATIONAL APPLICANTS

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Completed 25 December 2019

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