1/4/2017
Leeward Community College
Early Admission Program Request Form
Fall
Spring
Summer
Student Name:
(Last, First, Full Middle)
High School:
Application requirements for the Early Admission Program include:
1. Complete the UH System Application Form, apply.hawaii.edu
2. Complete this Early Admission Program Request Form
3. Official High School Transcript
4. Submit ALL documents to Leeward Community College by the published deadline
High school juniors and seniors seeking enrollment into Leeward Community College’s Early Admission
Program must meet ALL the following conditions:
1. Must be currently enrolled in high school
2. Must be in good academic standing
3. Requested course is limited to those courses not available at the high school
4. Approval from high school to enroll in one or more of the following courses listed below
List course(s) you are requesting to enroll in:
1.__________________________________
3.__________________________________
2.__________________________________
4.__________________________________
Applicant agrees to the following:
1. All program requirements and course prerequisites, including completion of placement tests at
specified levels must be met
2. UH Community College tuition and fees will apply
3. Enrollment into the requested course(s) is on a space available basis
4. Classroom supplies and textbooks are the responsibility of the student
Student Signature:
Date:
I approve/grant permission allowing the above student to participate in the Early Admission Program at Leeward
Community College. I understand that he/she will be enrolled in course(s) with other college students and may be
exposed to subjects that incorporate adult topics or themes. I acknowledge that the student academic record is
private and the college is not permitted to release private information due to federal privacy law (FERPA) without
written authorization from the student.
Parent Signature:
Date:
Counselor Signature:
Date:
Principal Signature:
Date:
CLEAR FORM
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