Fall Application Period: December 1 June 30
Directions: Please complete each item by typing directly into the fields or neatly printing on a hardcopy, and
submit this Admission Application Checklist with all required documents to a Health Sciences Counselor via
UH File Drop. We will not be accepting in-person applications during this application period.
To use file drop follow the directions below:
1. Scan application and all supporting documents
a. If you do not have access to a scanner, use a free smartphone app like Scannable or Scanner Pro
or Cam Scanner. Save your application and all supporting documents in PDF format.
2. From any web browser, go to https://www.hawaii.edu/filedrop
3. Log in as a UH User or Non-UH user (Non-UH Users will be sent a verification email, click on the link
in the email)
a. In the recipient field, type: hlthsci@hawaii.edu
b. Click in the drop down menu in the expiration timer, change it to 14 days
c. In the “Optional Message” field, enter FULL NAME and the PROGRAM you are applying to
d. After you’ve completed the Recipient field, extended the expiration timer, typed in the Optional
Message, click Proceed.
e. Click the Choose File button to browse for your application and supporting documents.
i. If you upload your docuemnts in different files (i.e. application, transcripts, etc), please
write a description of the file in the Description box.
f. Click the Start Upload button.
g. You will be redirected to a confirmation page with the link to your uploaded file. You’re
4. Once your application is reviewed, you will receive a confirmation email to indicate that your
application is complete or that you are missing items. If you are missing items, you must have a
complete application submitted by the application deadline.
Please contact us at hlthsci@hawaii.edu or 808-734-9224 if you have any questions or need assistance with
these temporary application submission procedures.
Health Sciences Department
Kapi`olani Community College
Admission Application Checklist
Fall Application Period: December 1 June 30
Directions: Please complete each item carefully typewritten or neatly printed, and submit this Admission
Application Checklist and all required documents to a Health Sciences Counselor during walk-in counseling hours.
If the application deadline falls on a weekend or recognized holiday, applications will be accepted on the
following business day. Only this completed program Admission Application including supplemental
documentation submitted to the Health Career Counseling Center (Kauila 106) by the appropriate deadline
will be accepted for processing. Applications must be submitted in person during walk-in counseling only.
Program Applying to: Certificate of Competence Certificate of Achievement
(Please check which program you are applying to)
Name: UH Number/Username
Last Name First Name M.I.
Street / POB City State Zip Code
Cell Home Work
UH SYSTEM Email Address:
List other name(s) used on documents:
(Notify the Kekaulike Information & Service Center regarding other names used on college documents.)
1. Attend a mandatory DENT Information Session within one year prior to application submission.
or more information visit www.kcc.hawaii.edu or pick up an Information Session schedule from Kauila 122 or Kauila 106,
Monday Friday during posted business hours.
Date Attended: (Month / Day / Year)
2. Complete the online UH System Application (New, Returning or Transfer) if you are not currently enrolled at any UH
System institution during the semester you submit your application. (http://apply.hawaii.edu)
3. Complete all DENT qualifying tests or equivalent courses prior to the end of the application period.
4. College transcripts for courses completed within the University of Hawai‘i System. Print out student
copy of unofficial transcripts for all course work WITHIN the UH System and highlight all qualification courses.
UH system transcripts are downloadable from the UH Portal (myuh.hawaii.edu
5. College transcripts for courses completed outside of the University of Hawai‘i System.
If transferring courses from institutions outside the UH System, please list the institution and when your official
transcript was sent to the Kekaulike Information & Service Center (KISC):
Institution: ___________________________ Transcript Request Date: ___________
Institution: ___________________________ Transcript Request Date: ___________
• I
nstitution: ___________________________ Transcript Request Date: ___________
Health Sciences Department
Kapi`olani Community College
Admission Application Checklist
My external transcripts have been evaluated by KCC. Submit your transfer course report from STAR
accessible via the UH Portal (myuh.hawaii.edu).
My external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center, complete Online
request for Transcript Evaluation. To complete this form, you must log in with your UH Email
account. Complete this form at: http://go.hawaii.edu/oxG
5. My
Plan Initiative.” Complete self assessments.
I certify that the answers and responses provided for all of the items on this Admissions Application/Check List are true to the best of
my knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements and/or
discipline measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program
of application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change
my major and home institution if I am accepted into the DENT program. I understand that if I am not accepted into the DENT
program, my home institution and major will not change.
Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not
satisfying academic program requirements. It is the responsibility of the student to satisfactorily complete any
background checks and drug testing that may be required by the affiliated health care facility to which he/she is
assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated health
care facility.”
I understand that a criminal background check and drug test may be required for entry into clinical practice. ________
(please initial)
also understand that clinical practice is required for completion of this program. ________ (please initial)
I understand that priority selection is given to Hawai‘i State residents for tuition purposes and that non-residents will be
considered after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
rint Name ____________________________ Signature ________________________ Date_____________
EXAMPLE of how to complete the application:
These are qualification criteria
Tell us how you meet each requirement
Test Score or
Course Alpha
Term of
Institution Grade
ACCUPLACER WritePlacer score
of 5
or qualification of ENG 100
Placement into
ENG 100
Date of
KCC Testing
for ENG 100
Health Sciences Department
Kapi‘olani Community College, Health Sciences and Emergency Medical Services Departments
4303 Diamond Head Road, Kauila 106 Honolulu, Hawai’i 96816-4421 Telephone: (808) 734-9224
Website: www.kapiolani.hawaii.edu
An Equal Opportunity/Affirmative Action Institution
Acceptance into the program is on a best-qualified, first-accepted basis. Qualification is based on (1) a
qualifying ACCUPLACER WritePlacer score of 5 or higher and (2) participation in a scheduled personal
advising session. Selection is based on total qualifying scores in rank order from the highest until the quota is
DENT Quafication
Required for admission
Term of
Instiution Coursework
ACCUPLACER WritePlacer score of 5
or qualification of ENG 100
Courses below are not required for admission into the Dental Assisting Certificate of Competence or Certificate
of Achievement programs. However, they may be completed prior to admission as they must be completed in
order to graduate form the Certificate of Achievement program.
Health Sciences Department
Application Summary: For office use only
Date Received: _____________________ Counselor’s Initials: _________________
Application Complete: _____________ HI Resident: Y N KCC GPA Verified: _______________
The purpose of the My Plan Self-Assessment is a counseling tool for prospective healthcare majors to
identify and better understand your career pathway including your strengths and areas of focus. Working in
healthcare requires a combination of academic and professional knowledge and skills and a commitment to
public service. As you plan, find ways to make your strengths shine and to improve your weaker areas. Please
complete areas of this self-assessment by marking the boxes. All response are voluntary. Consider discussing
your self-assessment with a counselor/advisor to understanding how they support your academic and career
Knowledge of the Profession
ied career goals in my health pathway
Identified career alternatives in my health pathway
Relevant experience by volunteer experiences
Relevant experience by servicing learning experiences
Relevant public serviceby paid work experiences
Understand “professional qualities” of health pathway(s)
Understanding of current healthcare issues
Comfort with bodily fluids or personal patient care
Comfort with illness
Comfort with injury
Comfort with death
Comfort with physical contact with people
Ability to multitask and adapt to change
Ability to accept constructive feedback
Ability to handle occupational crises, challenges or problems
Ability to move forward to achieve the goals and outcomes
Ability to follow safety guidelines and standards of practice
Personal Characteristics
rate commitment to public service
Demonstrate empathy/altruism
Demonstrate moral/ethical integrity
Demonstrate emotional maturity
Demonstrate good interpersonal relationships
Accept responsibility
Ability to work independently to achieve the goal/task
Collaborate and teamwork to achieve the goal/task
Accept and demonstrate leadership
Be dedicated/hard-working healthcare practitioner
Committed to life-long learning
Kapi`olani Community College
Self Assessment
Health Sciences Department
Academic Strength
+Completed prerequisites of health program of study
+Completed support courses of health program of study
Achieved minimum cumulative GPA for program entry
Achieved prerequisite course GPA for your program entry
Effective verbal and nonverbal communication skills
Ability to utilize technology effectively for learning
Established Support Systems to Succeed in
Health Pathway Program
Established support for transportation to externships
Established support for financial assistance prior to entry
Established support for nonacademic responsibilities
Established support for personal and time management skills
Established support for continuous professional learning
Established opportunities to balance personal, family, & school
Established support for campus and community resources
required for program entry and graduation or meet other requirements as directed for program admissions.
An Equal Opportunity/Affirmative Action Institution
Kapi`olani Community College
The University of Hawai‘i does not discriminate on the basis of race, sex, age, color, national origin, or disability. For
inquiries regarding our nondiscrimination policies, please contact the Kapiolani Community College designees:
Deneen Kawamoto, ADA Coordinator for Students Office:Ilima 107
(808) 734-9522; deneenk@hawaii.edu
UHCC offers Career and Technical Education (CTE) Programs of Study leading to Associate of Science (AS) and
Associate of Applied Science (AAS) degrees, as well as postsecondary certificates, in career fields such as arts and
communications, business, health careers, industrial and engineering technology, natural resources, and public and
human services.
For more information, visit our website at http://uhcc.hawaii.edu/programs/index.php
UHCC applies an open access policy, with program admission based upon the completion of applicable course/testing
prerequisites. The lack of English skills will not be a barrier to admission and participation in CTE programs.
Health Sciences Department