8/9/2019
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.
6. Letters of Recommendation: Applicants must submit three (3) letters of recommendation from
individualsrelated to your work, volunteer, and/or educational experiences in the health pathway. Letters
must include the recommenders signature, contact phone number and/or email. All letters o
f
reco
mmendation must be received by the date of your interview. Letters may be sealed and brought to th
e
i
nterview or may be mailed/emailed directly to the RESP Program Director prior to the interview at
:
B
ob Vega, RESP Program Director OR Bob Vega <robertlv@hawaii.edu>
Kapiolani Community College
Health Sciences Department, Kauila 122
4303 Diamond Head Road
Honolulu, HI 96816
__________ (initial)
7. Application Essay: A typed 400-500 word essay is required as part of the application. Details will be
provided during the RESP application period. The essay must be submitted to the Program Director on
the date of your scheduled interview.
_________ (initial)
APPLICANT CERTIFICATIONS:
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 RESP program.
I understand that if I am not accepted into the RESP 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 criminal
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 have read and understand the notification that a background check and drug test may be required for entry into clinical
practice. I 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)
Print Name ____________________________ Signature ________________________ Date_____________
Health Sciences Department
