Office of Admissions
Freshman Application Fee Waiver Request Form
STUDENT INFORMATION: Print or type the information requested below.
Name (Last, First, Middle Initial):
Mailing Address:
City, State, Zip Code:
Home Work Cell
Phone #:
( )
Date of Birth (mm/dd/yyyy): Email:
High School:
Semester/year applying for:
Login ID for online application
(if applicable):
WAIVER TYPE: Please check the box that indicates the basis for your request. Attach official documentation
of the waiver you have selected. Without official documentation, your request will not be considered. This
form alone does not constitute a request for an application fee waiver. In addition, fee waiver requests are not
guaranteed and the Office of Admissions will determine if a request is accepted or denied. If the waiver
request is denied, you will be contacted to pay the application fee.
Federal Free/Reduced Lunch Program
NACAC Fee Waiver
College Board SAT Program Fee Waiver Other (specify)
CERTIFICATION: Please sign/date and have your counselor sign/date below.
I certify that the information provided is complete and correct to the best of my knowledge. I understand that
any misrepresentation, falsification, or failure to supply required information may result in rejection of this
request and application.
Student's Signature: Date:
Counselor's Signature: Date:
Please submit this form along with the required supporting document to the University of Hawaiÿi at
Mänoa's Office of Admissions.
University of Hawaiÿi at Mänoa
Office of Admissions
2600 Campus Road, Room 001
Honolulu, HI 96822
Application Fee Waiver 10/25/11
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