%%% %
%
% %% % % %%% %
%
% %% % % % %%% %
%
% % % %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%% % %
% % % % % % % % % %
% % % % % % % % % % % % % %
%
% % % % % % % % % % % % %
% % %
% % % % % % % % % % % % % % % %
% % % % % %
% % % % % % % % % % % % % % % %
% % %
% % % % % % % % % % % % % % % % % %
% % %
% % % % % % % % % % % % % % % %
% % % % % % % % % % % % % % % %
%
% % %%% %
%
%
%
%
%
%
% % % % % %%% %
%
% % % % %%% %
%
% % % % % % % % % % % % % % % % % %
%
% %
%
%
% % %
% % %
%
% % %
% % % % %
%
% % %
% % % % % %
%
% % %
% % % % %
%
% % %
% % % % %
%
% % % % %
% % % % % %
%
% % %
% % % %
%
%
% % % % % % % % % % % % % % % % % % % % % %
% % % % % % % % % % % % % % % % % % %
% % % % % % % % % % % % %
% % % % % % %
%
% % % % % % % % % % % %
% %
%
2020-21% Concurrent% Enrollment% Form %
Student Name: UH% ID #/Username:
Phone Nu
mber: Date of Birth:
Current Ho
me Campus: Major at Home% Campus:
Term (Check One): Fall 2020 Spring 2021 Summer 2021
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 %hom e %ca mpus,
and enrolled in %courses %at %anoth e r %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 requirem en ts.
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 ar
e also responsible for informing the financial aid office of% any change s 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% enrollme nt% and/o r% transferre d.
I%am %certify in g %th at %I%un d e r st a n d %I%am %respon s ib le %fo r
%
paying
%
any%t uition
%
or
%
fee
%
charges
%
at
%
the
%
other
%
campus
%
and
%
if
%
approved,
%
the
%
financial
%
aid
%
received
%
may%n ot
%
cover
%
the
%
full
%
cost
%
of
%
tuition
%
and
%
fees
%
at
%
the
%
other
%
campus.
%
Student’s Signature: Date:
Institutio n
Course% Name
CRN
Credits
I%certify %that %the %co u rs e(s ) %app r o ve d %ar e %tran s fe rra b le %an d %ar e %ap p lica b le %to %th e %stu d en t ’s %deg re e %pr o g ra m .
Home Campus Academic Counselor Name: Date:
Home C
ampus Academic Counselor Signature:
RETURN THIS FORM ALONG WITH ANY OTHER% REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Community College
Address
Email
Hawaiʻi Community College
1175 Manono Street *% Hilo, HI 96720
hawccfao@hawaii.edu
Honolulu Community College
874% Dillingham Boulevard *% Honolulu, HI 96817
honccfao@hawaii.edu
Kapiʻolani Community College
4303% Diamond Head Road *% Hon olulu, HI 96816
kapfao@hawaii.edu
Kauaʻi Community College
3-1901% Kaumualiʻi Highway *% Lihuʻe, HI 96766
kauccfao@hawaii.edu
Leeward Community College
96-045% Ala% ʻIke% Street *% Pearl City, HI 96782
lccfao@hawaii.edu
University of Hawaiʻi Maui College
310% West Kaʻahumanu Ave *% Kahului, HI 96732
mauifa@hawaii.edu
Windward Community College
45-720% Keaʻahala% Road *% Kāneohe, HI 96744
wccfao@hawaii.edu
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 a
nd% contact information% are available at: https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
UH% HILO, UH% WEST OAHU% AND% UH% MĀNOA% STUDENTS NEED% TO CONTACT THEIR FINANCIAL AID% OFFICE FOR CAMPUS SPECIFIC FORMS.
Rev. 10/2019
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome