Application for Non F-1 Students Only

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1 Application for Non F-1 Students Only Please send completed application packet to: Maui Language Institute University of Hawai`i Maui College 310 West Kaahumanu Avenue Kahului, Hawaii, USA or scan and to: Checklist: All applicable documents below must be received for your application to be considered complete. Please include the following when submitting your application: USD$100 Application Fee* * Application Fees are non-refundable. This fee is not included in the cost of program prices. Payment for this fee must be submitted with your application. Completed applications must be received by the Application and Payment Deadline. Hawai`i state residents may qualify for an application fee waiver. Please contact MLI for information on Hawai`i state resident discounts. MLI Application Form MLI Health Certificate Form Copy of passport (Hawai ` i Resident applicants only) Hawai`i Residence Application and Fee Waiver Form. Payment of tuition and fees New students may pay for their tuition and required fees on the first day of orientation without incurring a late payment fee. Current tuition rates, fees, and deadlines can be found on the attached 2018 Tuition Schedule. MLI accepts cashier s checks or money orders made out to Maui Language Institute. Please allow 5-7 business days to process completed applications. For F1 visa applicants, delivery of I-20 forms typically take 5-7 business days after processing is complete. Maui Language Institute maui.hawaii.edu/mli Phone:

2 MLI Application Form Applicant Information Family Name as it appears on passport First Name Middle Name Preferred Name Home Country Permanent Mailing Address City Country Postal Code Home Country Telephone Hawaii Telephone Hawaii Mailing Address City Zip Code Country of Birth Country of Citizenship / / Birth Date (Month / Day / Year) Gender (circle one): Male Female MLI Information I am a Hawaii State resident. I am a United States citizen, or I am a lawful permanent resident (Green Card holder). I will be an F1 Visa student. I am entering on a B-2 (tourist) visa or WT status (visa waiver)** ** B-2 (tourist) visa or Visa Waiver applicants may NOT study full time at MLI, but may be eligible for part-time study (16 hours or less) incidental to visiting in Hawaii. US Citizens, Green Card holders, and F1 Visa student applicants: Circle all terms you plan to attend: Fall I 2018 Fall II 2018 Spring I 2019 Spring II 2019 Summer I 2019 Summer II 2019 Fall I 2019 Fall II 2019 B-2 (tourist) visa or Visa Waiver applicants: Date you plan to begin MLI: Month Day Year Date you plan to leave MLI: Month Day Year How did you hear about us? Internet / Website Family / Friend Other (please specify): Agent (name):

3 Maui Language Institute Admissions Application Fee Application fees are valid only for the term specified and are non-refundable and non-transferable. All applicants are required to make a payment of this non-refundable and non-transferrable application fee (by wire, money order, credit card, or cashier s check) upon submission of their applications. Applications are not considered complete until the application fee has been received by the University of Hawaii Maui College Maui Language Institute. Application fee is USD$100. Hawai`i residents may be eligible for an application fee waiver. Please complete the Application Fee Waiver form and submit to the Maui Language Institute office for consideration. Money Order or Cashier s Check Payments by money order or cashier s check should be made payable to: Maui Language Institute. The application fee is USD $100. Checks must be made out for the exact amount. Payments are accepted via mail or in person: University of Hawaii Maui College Maui Language Institute, Laulima W Kaahumanu Avenue Kahului, Hawaii USA Wire Transfers Please contact MLI for information on wire transfers.

4 Maui Language Institute Hawaii Resident Declaration and Admissions Application Fee Waiver Form Hawaii Resident Declaration and Application for Fee Waiver The University of Hawai`i is the state s public institution of higher learning. Public institutions are partially supported by state taxes. Therefore, the University of Hawai`i, like all other public universities in the nation, may charge nonresidents a higher tuition, since non residents do not contribute to the state s tax base. For more information on what constitutes a Hawai`i resident, please contact our office at uhmcmli@hawaii.edu or (808) Hawai`i residents may qualify for a 10% reduced tuition rate. In the event this application is not accepted, for whatever reason, the student will be responsible for the full cost of tuition and fees. If the student fails to register for the term by the deadline, application will be terminated. Application fees already paid prior to submitting this form are non-refundable and non-transferable. Last Name First Name Middle Name Preferred Name Phone Number address Permanent Address City Zip Code Please check all that apply: I am a U.S. citizen and currently reside in Hawai`i. I am a permanent resident (green card holder) and reside in Hawai`i. I have filed a Hawai`i resident personal income tax form. I have registered to vote in Hawai`i. I have proof employment in Hawai`i. Student Certification I certify that the information provided is complete and true to the best of my knowledge and belief. I understand that providing incomplete, incorrect or false information may result in the rescission of my admission. I understand that I may be required to produce certified documents to substantiate my claim for a waiver of the application fee. Student Signature Date To be eligible for a waiver of the application fee, you must be a permanent resident of the State of Hawaii. Your request must be verifiable.

5 MLI Health Certificate Form To be accepted to the Maui Language Institute students must comply with Hawai`i State health requirements by completing the Health Certificate Form. Family Name as it appears on passport First Name Date of Birth (Month / Day / Year) Measles Mumps Rubella (MMR) Immunization Two doses of live measles vaccine are required, with at least of the two being an MMR (Measles, Mumps, and Rubella). Measles immunization may be waived if (a) student was born before 1957; (b) there was documented history of disease; (c) there is serologic evidence of immunity. I have received the MMR immunization or I am eligible for the Measles immunization waiver (please attach a copy or complete the UHMC Health Clearance Form with physician signature). I do not have the required MMR immunizations. I will receive the immunizations at the UHMC Health Center upon arrival in the U.S. (MMR cost is USD$15 ) Tuberculin Examination A Tuberculin skin test (PPD Mantoux) within one year prior to enrollment is required. Skin test results must be read in 48 to 72 hours. If positive, a chest x-ray is required. If you attend more than six months in our program, you will be required to take an additional TB test in the State of Hawaii. Students MUST take the test in the United States or by a US licensed Healthcare provider (MD, DO, APRN, or PA). TB Tests from other countries are NOT admissible. I have received a TB clearance dated within one year of the first day of MLI (please attach a copy of TB clearance or complete the UHMC Health Clearance Form with physician signature). I do not have the required Tuberculin Examination (TB Test). I will get a TB Test at the UHMC Health Center upon arrival in the U.S. (TB Test cost is USD$20 ) Medical Insurance All international students must have health coverage while attending MLI. I have my own health coverage that is valid in the U.S. (please attach a copy). I will have my own coverage that is valid in the U.S. when I arrive to Maui and I will provide MLI a copy of my health insurance plan by the first day of orientation. Health Clearance Checklist Complete the MLI Health Certificate Form Copies of MMR Immunization and/or TB Test clearance if applicable Copy of medical insurance card

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