Fillable UNIVERSITY OF HAWAII Supplemental Information Form for Undergraduate (University of Hawaii at Hilo)

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UNIVERSITY OF HAWAII Supplemental Information Form for Undergraduate (University of Hawaii at Hilo)

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UNIVERSITY OF HAWAII
Supplemental Information Form for Undergraduate International
Applicants
Who should complete this form:
- Applicants whose native language is not English,
- Applicants who were born outside the United States and/or who graduated from a foreign high
school.
-
Applicants requiring an F-1 or J-1 student visa (I-20 or DS-2019).
INSTRUCTIONS:
Please fill out your name as submitted on the System Application Form and high school records. Use the
same sequence in your names to avoid confusion in the documentation of your records.
For example, if you file your application as
your admissions documents
must be submitted under Fong, Shiu Ling Ann and not as Fong, Ann Shiu Ling.
Complete the System Application Form and submit it with the appropriate application fee to your first-
choice campus if you have not yet done so. Submit this Supplementary Information Form and all other
required documents such as the Test of English as a Foreign Language (TOEFL), Scholastic Assessment
Test (SAT-1) scores, if required, and all school transcripts by the specified deadline.
International undergraduate students are required to enroll in a minimum of 12 credit hours per semester.
Note: The number of credit hours of on-line coursework is restricted for international students who are
physically present in the United States. The estimated Cost of Attendance is calculated based upon two
semesters and includes Cost of Living plus Tuition.
Contact the campus you are applying to for more information on Cost of Attendance.
Contact Information by Campus
University of Hawai'i at Manoa
manoa.admissions@hawaii.edu
1-808-956-8975
University of Hawai'i at Hilo
uhhfao@hawaii.edu
1-808-932-7449
University of Hawai'i West O'ahu
uhwo.admissions@hawaii.edu
1-808-689-2900
Hawai'i Community College
(on Hawai'i Island)
hawccar@hawaii.edu
1-808-969-8816
Honolulu Community College
honcc@hawaii.edu
1-808-845-9129
Kapi‘olani Community College
kapfao@hawaii.edu
1-808-734-9537
Kaua‘i Community College
arkauai@hawaii.edu
1-808-245-8225
Leeward Community College
lccfao@hawaii.edu
1-808-453-6371
Maui College
uhmcar@hawaii.edu
1-808-479-6692
Windward Community College
1-808-235-7449
Fong Shiu Ling Ann
(family first middle)
Rev. UHSYSSA 1/15/2021
Supplemental Information Form for Undergraduate International Applicants
1
CONTACT INFORMATION
Last (Fami
ly) Name: ______________________ First Name: ______________________ Middle Name: _____________
Email:______________________________ Contact Phone # ____________________ Student ID # ________________
SECTION A — EDUCATIONAL INFORMATION
1. List all sch
ools attended, regardless of length of attendance, and include any you are now attending.
Name of institution
(do not use initials)
Location
(City, Country)
From
Mo/Yr
Name of Dipl
or Cert
Date
Rec’d
Primary Schools (starting from grade 1, transcripts not required):
Secondary or Middle Schools (transcripts required):
2. What is yo
ur native language? _____________ What
is the primary language spoken at home? ___
_____________
3.
How many years have you studied in a school where English is the language of instruction? ______
____________
a. In secondary or middle school from (month/year) _______________/ to (month/year) ______________
b. In university or college from (month/year) _______________/ to (month/year) ______________
4. If you have taken/will take the test of English as a Foreign Language (TOEFL), specify test date: ______________
5. Why did you select the University of Hawaii?
6. Provide additional information that may be helpful in evaluating your application, such as employment, talents, skills,
fellowships or scholarships held.
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 it is my responsibility to
arrange for the forwarding of official transcripts of records from all secondary and post-secondary schools that I have
attended, and that such transcripts and other application materials will become the property of the University of
Hawaii and will not be returned to me nor be available for distribution.
Printed Name: _____________________________ Signature: _____________________________ Date: ____________
Rev. UHSYSSA 1/15/2021
Supplemental Information Form for Undergraduate International Applicants
2
SECTION C — CONFIDENTIAL FINANCIAL INFORMATION
Applicants requiring an I-20 or DS-2019 for an F-1 orJ-1 (student) visa/status must complete this section. Failure to complete this
section may affect compliance with federal immigration regulations requiring non-immigrant student visa holders to document
sufficient funds to provide for their academic studies in the United States.
I. Personal information
1. Name of student: Date of Birth:
Family First Middle
2. Permanent address in home country:
3. City & Country of Birth:
4. Do you plan to enter the U.S. from abroad? □No □Yes
5. Do you currently hold a U.S. visa? □No □Yes If yes, type of visa: _____
6. Name of school that issued your last I-20 or DS-2019:
7. If in the U.S., give your SEVIS I.D. number: ____________________
8. If you plan to bring dep
endents, list their names and information in the space below. Provide evidence that
approximately $4,000 per year/ per dependent is available above the amount required for yourself:
Name
SEVIS I.D.#
City & Country of Birth
Country of Citizenship
Relationship
Gender
II. Family or Sponsors Support
9. Name of sponsor: Phone:
10. Address: Email: ________________ _______
11. Relationship to student: ________________ Yearly amount of student support in U.S. $______________________
12. If you expect to receive a grant/loan, please provide the name and address of the sponsoring agency:
_______________________________________________________________________________________________
CERTIFICATION
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 Hawaii.
Printed Name: _____________________________
Signature: _____________________________ Date: ____________
III. Bank Verification for Visa Purposes
13. Name of bank (agency):
14. Address:
15. Name of account holder: ______________________________ Date account opened: (MM/DD/YYYY): ____________
I certify that the above-named sponsor has the amount on deposit with our institution sufficie
Printed Name: __________________________________________
Title: __________________________________________________
Signature: _______________________________________________
Country:
______________________
Phone:
___________________________
Confirmed by bank employee:
provide financial support to the applicant. This certification is offered with no responsibility on the p
this bank or financial agency.
16. Type of account: Checking Savings Certificate of deposi
nt t
art
[
t
o
of
Place bank seal or stamp in area above.
]
Date: ______________________
Rev. UHSYSSA 1/15/2021
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UNIVERSITY OF HAWAII Supplemental Information Form for Undergraduate (University of Hawaii at Hilo)

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Completed 2 February 2021

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