UNIVERSITY OF HAWAI`I AT HILO
Application Form
Academic Year __________ - __________
PLEASE TYPE OR PRINT CLEARLY IN INK. COMPLETE THIS FORM AND
SUBMIT IT TO THE ADMISSIONS OFFICE.
Social Security # Legal Name: Family/Last First/Given Full Middle Any Other Names Used
Current Mailing Address: Street City/Province State/Country Zip/Postal Code Until (M/D/Y) Phone Number(s)
Gender Birthdate (MM/DD/YY)
/ /
Birthplace (State or Foreign Country) Citizenship Non-US Citizenship--Visa Type (Attach copy-greencard)
Name of High School Graduated / Will Graduate From State / Country of High School Graduation Date
/
Permanent Address: Street City/Province State/Country Zip/Postal Code
Email Address(es) Were any of your ancestors Hawaiian?
Race (Select One or more)
African or Black (AA)
American Indian (AI)
Caucasian / White (CA)
Asian Indian (IN)
Chinese (CH)
Filipino (FI)
Japanese (JP)
Korean (KO)
Laotian (LA)
Thai (TH)
Vietnamese (VI)
Other Asian (OA)
Native Hawaiian / Part-Hawaiian / Mixed-Hawaiian (HW)
Samoan (SA)
Tongan (TO)
Guamanian / Chamorro (GC)
Micronesian (MC)
Other Pacific Islander (OP)
List your choice of Campuses and Academic Program you are seeking
Campus Academic Program
University of Hawai`i at Hilo
List every College, University, Business and Post-Secondary School Attended, including any UH Campus, and the one you are currently attending, if any
Name of Institution
(Do not use initials) Attach additional sheet
List most recent first if necessary
City / State
or
City / Country
Attended / Attending
From To
(MM/YY) (MM/YY) Major
Name of
Degree, Diploma
or Certificate
MM / YY
Expected/
Received
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--
--
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I certify that the answers and responses provided for all of the items on the University of Hawai`i at Hilo Application Form are complete and true to the best of my knowledge
and belief. I understand that providing incomplete, incorrect, or false information may result in the recision of my admission and subject me to the requirements and/or disciplinary
measures as provided under the University's Student Conduct Code. Furthermore, I understand that I may be required to produce certified documents relative to the
determination of my residency status and that the provision of incorrect information regarding my residency declaration will also subject me to the requirements and/or disciplinary
measures provided for in the University's rules and regulations governing the determination of residency for admission and tuition purposes.
Complete this section if you are currently enrolled in a College or University (attach additional sheet if necessary)
Name of College or University currently attending Credit Hours Location (City / State) Term/Year Currently Enrolled
APPLICANT's CERTIFICATION
RESIDENCY: Do you wish to claim residency in the State of Hawaii?
Yes (submit Residency Declaration) No
Yes No
Date ____________________________________ Signature ________________________________________________________________________________
Male
Female
Other
USA
Student Visa
Immigrant - Date Rec
Other
Fall
Spring
Ethnicity (Select One)
Hispanic or Latino
Not Hispanic or Latino
Hispanic or Latino:
A person of Cuban, Mexican,
Puerto Rican, South or Central
American, or other Spanish
culture or origin, regardless of
race.
(By entering your last name on the line above, you agree that it is the same as your signature)
