For Office Use Only
_______ _______
Paid Initial
READ & FILL OUT COMPLETELY | PRINT CLEARLY & LEGIBLY:
NAME: ___________________________ ___________________________ ____
LAST FIRST MI
UH NUMBER: ___________________ E-MAIL: _____________________@ HAWAII.EDU
This ID card is also your KCC Library card. By signing this form you are hereby agreeing to conform to the UH Library and
KCC ID polices. For more information go to http://library.kcc.hawaii.edu/library_info/policies.php
Revalidate your ID every Semester at no cost. Replacement ID costs $5 (CASH ONLY) FALL ___ SPR ___ SUM ___
IS THIS YOUR FIRST KCC ID? YES ___ NO___ CREDIT ___ NON-CREDIT ___
_____________________________________________________________ ___________________
SIGNATURE OF STUDENT DATE
All identification cards issued by OSA are the property of Kapi‘olani Community College and are non-transferable.