UNIVERSITY OF HAWAI‘I AT MĀNOA ▪ GRADUATE ADMISSIONS APPLICATION FORM
Mail to: University of Hawai‘i at Mānoa Office of Graduate Education- Student Services • 2540 Maile Way, Spalding 354 • Honolulu, HI
96822 • Tel:808.956.8544 V/T:808.956.4257 • Email: gradss@hawaii.edu • Web: http://manoa.hawaii.edu/graduate/
PLEASE TYPE OR PRINT CLEARLY.
SEMESTER
FALL 20____
SPRING 20____
1. ETHNICITY (Check
one) See instructions,
page 5.
Hispanic or Latino
Not Hispanic or Latino
RACE See instructions for listing, page 5.
AA AI CA CH FI
GC HW IN JP KO
LA MC OA OP SA
TH TO VI
GENDER
FEMALE
MALE
BIRTHPLACE (State or Country)
BIRTH DATE
MM DD YY
____/____/____
U.S. Social Security Number, if any.
____ - ____ - _____
2. FULL LEGAL NAME (Do not use nicknames. International applicants: Use name as listed on passport.)
FAMILY/LAST FIRST FULL MIDDLE
3. OTHER NAMES (under which transcripts, records, or
test scores may be issued):
US National or CFAS Citizenship*
U.S. Permanent Resident*
(Attach a front and back copy of your “green” card.)
CURRENT MAILING ADDRESS CITY/PROVINCE STATE/COUNTRY
ZIP/POSTAL CODE
VALID UNTIL (MM/DD/YY)
CURRENT TELEPHONE
Area Code ( )
PERMANENT MAILING ADDRESS CITY/PROVINCE STATE/COUNTRY
ZIP/POSTAL CODE
PERMANENT TELEPHONE
Area Code ( )
OTHER TELEPHONE
Area Code ( )
5. EMAIL ADDRESS FAX NUMBER Area Code ( )
6. INTENDED GRADUATE PROGRAM AND DEGREE OBJECTIVE (Refer to above website for listing of programs
and degrees.) PBU applicants: Leave section blank. Check box 7.
7. POST-BACCALAUREATE UNCLASSIFIED
8. CHANGE IN GRADUATE PROGRAM
9. READMISSION
10. DUAL DEGREE PROGRAM
Have you applied for graduate or PBU
admissions to UHM previously?
No Yes (semester & year) ___________
Were any of your ancestors
Hawaiian? (optional)
No Yes
11. Person authorized by you to access info regarding your
application status:
NAME OF HIGH (SECONDARY) SCHOOL FROM WHICH YOU GRADUATED STATE or COUNTRY GRADUATION DATE (MM/YY)
SUMMARY OF COLLEGE/UNIVERSITY ATTENDANCE. List bachelor’s degree(s) first; advanced degree(s) second, if any; and all other institutions of
college/university level, regardless of the length of attendance. International applicants: List actual name of degree received or expected. Use page 2 to list
additional institutions.
FULL NAME OF INSTITUTION
(Do not use initials.)
City/State or City/Country
Attended from
( MM / YY)
Attended to
(MM / YY)
MAJOR or PROGRAM
OF STUDY
NAME OF DEGREE or
DIPLOMA
EXPECTED/
RECEIVED
( MM / YY)
____/____
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____/____
____/____
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____/____
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____/____
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FOR OFFICE USE ONLY
APPLICATION FEE
CC CH
R N M F J S G C E H
TUITION STATUS: by on
ADMISSIONS TYPE
ST (Standard) CC (Concurrent) CH (Change)
STUDENT TYPE M R C T
GEOG L M I
UH ID:
1 of 3 SIGNATURE REQUIRED ON NEXT PAGE
Name of Applicant
Date of Birth (MM//DD/YY)
SUMMARY OF COLLEGE/UNIVERSITY ATTENDANCE: Continued from page 1.
NAME OF INSTITUTION
(Do not use initials.)
City/S state or City/Country
Attended from
( MM / YY)
Attended to
(MM / YY)
MAJOR/
PROGRAM OF STUDY
NAME OF DEGREE
OR DIPLOMA
EXPECTED/
RECEIVED
( MM / YY)
____/____
____/____
____/____
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How did you learn about the UHM graduate programs? Check all that apply.
a. UHM Web site
b. UHM Alumni
c. UHM Faculty
d. UHM Brochure
e. Recruitment Fair
f. Other Faculty recommendation
g. Reputation/Strength of Program
h. College/University Guide
I. Newspaper/Advertisement
j. Parent
k. Friend
l. Other __________________________
12. APPLICANT’S CERTIFICATION
I certify that the responses provided on the Graduate Admissions 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 rescission of admission and subject
me to the requirements and/or disciplinary measures as provided under the University’s Student Code. Furthermore, I understand that
the UH System shares a common database and information pertaining to me may be accessed by all UH campuses.
Signature ___________________________________________________________________Date__________________________________
RESIDENCY: Do you wish to claim residency in the State of Hawai‘i? Yes (Submit the Residency Declaration form.) No
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Attach the completed payment form to the front of your admissions application.
Graduate Admissions or Post-Baccalaureate Unclassified Application Fee Credit Card Payment Form
Semester of Application (Please check one) Fall 20____ Spring 20____ Date of Birth ____ ____/____ ____/XXXX
MM DD YYYY
Name of Applicant ____________________________________________________________________________________________
FAMILY/LAST FIRST FULL MIDDLE
Credit Card Type: VISA MasterCard Diners
Account Number ____ ____ ____ ____/ ____ ____ ____ ____/ ____ ____ ____ ____/ ____ ____ ____ ____
Expiration date ____ ____/ ____ ____
Provide the three (3) digit security code located on the back of your credit card at the end of the signature line:____ ____ ____
Name of Card Holder (As indicated on card)________________________________________________________________________
FAMILY/LAST FIRST FULL MIDDLE
Billing Address _______________________________________________________________________________________________
Number and street Apt. Number City State Zip/Postal Code
Application fee - US$100.00
I agree to pay the appropriate graduate admissions application fee according to the card issuer agreement. I understand that
the application fee is non-refundable and non-transferable.
All tuition and fee charges at the University of Hawai‘i campuses are subject to change in accordance with requirements of State law
and/or action by the Board of Regents or university administration.
Card Holder Signature _____________________________________________________Date_____________________________
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