2019-20 Concurrent Enrollment Form
Student Name:
Phone Number:
Current Home Campus:
UH ID #:
Date of Birth:
Major at Home Campus:
Term (Check One): Fall 2019 Spring 2020 Summer 2020
Conditions to receive financial aid for courses at another campus within the University of Hawaiʻi System:
1. Have a University of Hawaiʻi System campus declared as your home campus, declared major at your
home campus, and enrolled in courses at another UH campus.
2. Must meet with an academic counselor to ensure that the other UH campus’ courses will meet and
transfer into your degree/certificate program at your home campus.
3. Must register for at least one credit course at your home campus. Contact your home campus financial aid
office for specific requirements.
4. Must complete and submit this form to your home campus financial aid office no later than 30 days
prior to the last day of the semester.
You are also responsible for informing the financial aid office of any changes in enrollment (i.e. withdrawals, adds,
and/or drops). Credit hours will be calculated into your satisfactory academic progress for all courses that are approved
for concurrent enrollment and/or transferred.
I am certifying that I understand I am responsible for paying any tuition or fee charges at the other campus and if
approved, the financial aid received may not cover the full cost of tuition and fees at the other campus.
Student’s Signature: Date:
I certify that the course(s) approved are transferrable and are applicable to the student’s degree program.
Home Campus Academic Counselor Name: Date:
Home Campus Academic Counselor Signature:
RETURN THIS FORM ALONG WITH ANY OTHER REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Hawaiʻi Community College
1175 Manono Street * Hilo, HI 96720
Honolulu Community College
874 Dillingham Boulevard * Honolulu, HI 96817
Kapiʻolani Community College
4303 Diamond Head Road * Honolulu, HI 96816
3-1901 Kaumualiʻi Highway * Lihuʻe, HI 96766
Leeward Community College
96-045 Ala ʻIke Street * Pearl City, HI 96782
University of Hawaiʻi Maui College
310 West Kaʻahumanu Ave * Kahului, HI 96732
Windward Community College
45-720 Keaʻahala Road * Kāneohe, HI 96744
The University is committed to a policy of nondiscrimination on the basis of race, sex, gender identity and expression, age, religion, color, national origin, ancestry, citizenship, disability, genetic
information, marital status, breastfeeding, income assignment for child support, arrest and court record (except as permissible under State law), sexual orientation, national guard absence, or
status as a covered veteran. UH Title IX Coordinators' names and contact information are available at: https://www.hawaii.edu/titleix/help/coordinator/ and UH 504 Coordinators’ names and
contact information are available at: https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
UH HILO, UH WEST O‘AHU AND UH MĀNOA STUDENTS NEED TO CONTACT THEIR FINANCIAL AID OFFICE FOR CAMPUS SPECIFIC FORMS.
Rev. 10/2018
