1/5/2017
Leeward Community College
Homeschool Student
Early Admission Program Request Form
Fall
Spring
Summer
Student Name:
(Last, First, Full Middle)
Application requirements for the Homeschool Early Admission Program include:
1. Complete the UH System Application Form, apply.hawaii.edu
2. Complete this Homeschool Early Admission Program Request Form
3. Submit valid copy of the State of Hawaii Department of Education’s Exceptions to Compulsory
Education form (4140)
4. Must meet the minimum age of 16
5. Submit ALL documents to Leeward Community College by the published deadline
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 for my son/daughter to participate in the Homeschool 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.
Print Parent Name:
Parent Signature:
Date:
CLEAR FORM
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