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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:
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:
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 *% Hon olulu, 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 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
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