9/12/2019
Health Sciences Department
My external transcripts have been evaluated by KCC. Submit your transfer course report from STAR
accessible via the UH Portal (myuh.hawaii.edu).
My external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center, complete Online
request for Transcript Evaluation. To complete this form, you must log in with your UH Email
account. Complete this form at:
http://go.hawaii.oxG
7. Typing
Test – A typing test is required as part of the application process. Details regarding the test date will be
provided after your completed application is reviewed.
8. Work/Volunteer Experience – You will be given points for any work/volunteer experience you have. You will
be given a verification form to complete when you come in for your typing test.
9. “My Plan Initiative.” Complete self-assessments.
APPLICANT CERTIFICATIONS:
I certify that the answers and responses provided for all of the items on this Admission Application are true to the best of
my knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements
and/or disciplinary measures as provided under the Student Conduct Code. I understand that if I am not accepted into the
program of application, I must submit a new application and all required documents for any subsequent semester. I also
allow KISC to change my major and home institution if I am accepted into the MEDA program. I understand that if I am
not accepted into the MEDA program, my home institution and major will not change.
“Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not
satisfying academic program requirements. It is the responsibility of the student to satisfactorily complete any
criminal background checks and drug testing that may be required by the affiliated health care facility to which
he/she is assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated
health care facility.”
I understand that a criminal background check and drug test may be required at my expense for entry into clinical practice.
________ (please initial)
I unde
rstand that clinical practice is required for completion of this program. ________ (please initial)
I understand that there is no renumeration for externship practicum hours. ________ (please initial)
I understand the AS degree may take more than one additional year if I do not place directly into Math 100. ________
(please initial)
I u
nderstand that priority selection is given to Hawai‘i State residents for tuition purposes
and that non-residents will be
considered after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
Pr
int Name ____________________________ Signature ________________________ Date_____________
