Reconsideration Form - Kamehameha Schools
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4FINANCIAL AID & SCHOLARSHIP SERVICES RECONSIDERATION REQUEST FORM
Parent(s)/Student have the opportunity to request a reconsideration of the application status or decision if an application has
been denied, award has been cancelled or reduced, or changes in personal circumstances have occurred no later than 30 days
after a program deadline.
Na Ho’okama a Pauahi Scholarship
Programs:
KS Summer School
Pre-School to 12 Grade
Process:
1.
Complete and submit the reconsideration request form with required supporting documentation (refer to attached list)
within 30 calendar days from the date of your KS notification or decision letter. Reconsideration request form submitted
with no supporting documentation will NOT be processed.
2.
The reconsideration request form with change in circumstances must be submitted no later than 30 days of the change
occurrence. Reconsideration request form submitted after the submission period will NOT be reviewed or processed.
3.
A decision notification of your reconsideration request will be mailed in approximately 30 calendar days from the receipt
of the reconsideration request form and ALL required supporting documents.
Required Applicant Information
Last Name _______________________________________________
First Name ______________________
MI ____
Date of Birth (MM/DD/YYYY) _____________________________
Email Address: ______________________________
Address _________________________________________________
Contact phone # (____) ______ - _________ (cell)
City, State, Zip ___________________________________________
Contact phone # (____) ______ - _________ (work)
If applicable:
Summer School
Program
KS Campus
Kapālama
Pre-School to 12 Grade
Pukalani Maui
Nā Ho‘okama a Pauahi
Kea‘au Hawai‘i
Name of Institution:
__________________________________________
CERTIFICATION: By signing this form, I/we certify that all information provided on this form and supporting
documentation submitted is true and complete to the best of my/our knowledge.
Applicant’s Signature ____________________________________________________
Date ________________________
Document No. 65
Rev. 3/1/2017
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