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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).
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
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.
UH Manoa
Cost of Living*
Non-Resident Tuition*
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)
Note: Tuition rates listed are for 12 credit hour enrollment in fall and spring semesters.
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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
Name of
Dipl or Cert
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 Hawaii?
7. Provide additional information that may be helpful in evaluating your application, such as employment, talents, skills, fel-
lowships or scholarships held.
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 Hawaii and will not be returned to
me nor be available for distribution.
Printed Name:____________________________________________________________________________________________
Signature:___________________________________________________________ Date:________________________________
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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 Sponsors Support
Name of sponsor:_________________________________________________________ Phone:__________________________
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
Hawaii (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:____________________
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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