Fill - Free fillable UNIVERSITYOFHAWAII SupplementaryInformationForm forUndergraduateInternational Applicants (University of Hawaii at Hilo) PDF form

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UNIVERSITYOFHAWAI‘I

SupplementaryInformationForm

forUndergraduateInternational

Applicants

Academic Year2019-2020

Who should complete this form:

• Applicants whose native language is not English, who were born outside the United States, or

who graduated from a foreign high school.

• Applicants requiring an F-1 or J-1 student visa (I-20 or DS-2019).

INSTRUCTIONS:

1. Print your name along the right edge of this form exactly as submitted on the S

ystem Application

Form and high school records. Use the same sequence in your names to avoid confusion in the

documentation of your records.

Fong Shiu Ling Ann

For example, if you le your application as

(family rst middle)

all your admissions documents must be submitted under Fong, Shiu Ling Ann and not as

Fong, Ann Shiu Ling .

2. Complete the S

ystem Application Form and submit it with the appropriate application fee to your

rst-choice campus if you have not yet done so. Include this Supplementary Information Form and

submit 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 specied

deadline.

3. In general, international undergraduate students are required to enroll in a minimum of 12 credit

hours per semester. Note: The number of credit hours of online coursework is restricted for

international studen

ts who are physically present in the United States. Contact your campus for

more information.

Estimated Cost of Attendance for two semesters equals Cost of Living plus Tuition. Use table below.

Campus

UH Manoa

Cost of Living*

$19,078

Non-Resident Tuition*

$33,336

UH Hilo $19,078 $20,304

UH West Oahu $19,078 $20,304

UH Maui College (below 300 level) $19,078 $ 8,280

UH Community Colleges $19,078 $ 8,280

Print name_________________________________________________________________________________________________________

(Last or Family Name) (First) (Full Middle Name)

*Subjecttochange.

Note: Tuition rates listed are for 12 credit hour enrollment in fall and spring semesters.

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SECTION A — EDUCATIONAL INFORMATION

1. List all schools attended, regardless of length of attendance, and include any you are now attending.

Name of institution

(do not use initials)

Location From

Mo/Yr

To

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 your native language?___________________________________________________________________

3. What is the primary 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)___________________

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?

7. Provide additional information that may be helpful in evaluating your application, such as employment, talents, skills, fel-

lowships 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 ocial 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 Hawai‘i and will not be returned to

me nor be available for distribution.

Printed Name:____________________________________________________________________________________________

Signature:___________________________________________________________ Date:________________________________

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signature

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SECTION C — CONFIDENTIAL FINANCIAL INFORMATION

Applicants requiring an I-20 or DS-2019 for an F-1 or J-1 (student) visa/status must complete this section. Failure to complete this

section may aect compliance with federal immigration regulations requiring non-immigrant student visa holders to document

sucient funds to provide for their academic studies in the United States.

I. Personal Information

Name of student:_____________________________________________________________ Date of Birth:__________________

Family First Middle

Permanent address in home country:__________________________________________________________________________

________________________________________________________________________________________________________

E-mail address:________________________________________________________

Do you plan to enter the U.S. from abroad? No Yes

Do you currently hold a U.S. visa? No Yes If yes, type of 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 birthdates 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. # Birthdate Country of Birth Country of Citizenship Relationship Gender

________________________________________________________________________________________________________

_________________________________________________________________________________________________________

________________________________________________________________________________________________________

II. Family or Sponsor’s Support

Name of sponsor:_________________________________________________________ Phone:__________________________

Address:________________________________________________________________________________________________

Relationship to student:______________________________________ Yearly amount of support in U.S. $_________________

If you expect to receive a grant/loan, please provide the name and address of the sponsoring agency:

_______________________________________________________________________________________________________

By signing this adavit of support, I (or my organization) agree to be nancially 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 (or for ____________years).

Signature of sponsor:____________________________________________________________ Date:_____________________

III. Bank Verication for Visa Purposes

Bank seal or stamp

I certify that the above-named sponsor has the amount on deposit with our

institution sucient to provide nancial support for (indicate name of student)

_______________________________________________________________

This certication is oered with no responsibility on the part of this bank or

nancial agency.

Name of bank (or agency):______________________________________________________ Country:____________________

Address:________________________________________________________________________________________________

Name of account holder:__________________________________________________________________________________

Type of account: savings certicate of deposit other___________

Date account opened: Month__________ Day_______________ Year________________

Conrmed by bank employee:

Name:____________________________________________________ Title:__________________________________________

Signature:_________________________________________________ Date:_________________________________________

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