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
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 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 (or for ____________years).
Signature of sponsor:____________________________________________________________ Date:_____________________
I certify that the above-named sponsor has the amount on deposit with our
institution sufficient to provide financial support for (indicate name of student)
_______________________________________________________________
This certification is offered with no responsibility on the part of this bank or
financial agency.
Name of bank (or agency):______________________________________________________ Country:____________________
Address:________________________________________________________________________________________________
Name of account holder:__________________________________________________________________________________
Type of account: savings certificate of deposit other___________
Date account opened: Month__________ Day_______________ Year________________
Confirmed by bank employee:
Name:____________________________________________________ Title:__________________________________________
Signature:_________________________________________________ Date:_______________