Fillable University of Hawaii at Hilo Supplementary Information for (University of Hawaii at Hilo)

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University of Hawaii at Hilo Supplementary Information for (University of Hawaii at Hilo)

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University of Hawai‘i at Hilo • Supplementary Information for International Students
Admissions Office • 200 West Kāwili St. • Hilo, HI 96720-4091 USA Tel. (808) 932-7446, Fax (808) 932-7459 • E-mail: uhhadm@hawaii.edu • Web: hilo.hawaii.edu
CONFIDENTIAL FINANCIAL STATEMENT FORM FOR INTERNATIONAL
APPLICANTS (SECTION C only)
INSTRUCTIONS: Attach official bank statement(s) if your bank will not complete the BANK VERIFICATION section. If sponsored by
a
government or private organization, a signed award letter is required. Bank statements may not be more than 90 days old.
Mail-in completed form and documentation to the address above, or submit by fax or e-mail attachment.
Type or print clearly. Where not applicable, write “N/A” Use names as listed on passport:
Family/Last Name First Name Middle Name
City of Birth Country of Birth Country of Citizenship
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 application materials will become the property
of the University of Hawai‘i at Hilo and will not be returned to me nor be available for distribution.
Printed Name:
Signature: Date: (MM/DD/YY)
(by entering your last name on this line, you agree that it is the same as your signature)
SECTION A - EDUCATIONAL INFORMATION
1. List schools attended, and include the one you are now attending.
Name of Institution
(do not use initials)
Location
From
Month/Yr
To
Month/Yr
Name of Diploma/
Certificate
Date
Received
Month/Yr.
Primary Schools (no transcripts required):
Secondary or Middle Schools (no transcripts required):
2. What is your native language? 3. What is the 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) MM/DD/YY
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 at Hilo?
7. Provide additional information that may be helpful in evaluating your application, such as employment, talents, skills, fellow-
ships or scholarships.
Page 1 of 2
SECTION C - CONFIDENTIAL FINANCIAL INFORMATION
Applicants requiring an I-20 or DS-2019 for the F-1 or J-1 (student) visa/status must complete this section. Non-immigrant student
visa holders are required to document sufficient funds for provide for their academic studies in the United States.
Do you plan to enter the U.S. from abroad?
q
No
q
Yes Do you currently hold a U.S. visa?
q
No
q
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 required information in the spaces below.
Provide evidence that approximately $4,000 per year/per dependent is available above the amount required for yourself:
Name Birth Date
Country of
Birth
City of Birth
Country of
Citizenship
Relationship Gender
II. Name of sponsor: Phone:
Address:
Relationship to student: Yearly amount of support in U.S. $:
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 Hawai‘i at Hilo (or for years).
Signature of Sponsor: Date:
Permanent Address in Home Country Date of Birth E-mail Address
I. Family/Last Name: First Name: Middle Name:
Page 2 of 2
Bank Seal or Stamp
III. BANK VERIFICATION
This is to certify that the
q
sponsor
q
applicant listed above is financially capable of the monetary support indicated above
and if the funds are outside the U.S.A., there are no government restrictions regarding the release of the funds.
This certificate is offered with no responsibility on the part of this bank or financial agency.
Name: Type of Account: Date Opened:
Account Holder (MM/YY)
Name &
Address of Bank:
Name of
Bank Official: Title:
Name of
Bank Official: Date:
(check one)
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Completed 2 February 2021

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