Verification Of U.s. Armed Forces Members Assignment In Hawai'I

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Kekaulike Information and Service Center
VERIFICATION OF U.S. ARMED FORCES MEMBERS ASSIGNMENT IN HAWAI‘I
Instructions: Applicants who members or authorized dependents of a member of the U.S. Armed Forces on
active duty stationed in Hawai‘i or members of the Hawai‘i National Guard or Hawai‘i-based reserves are
eligible for the Non-Resident tuition differential. Return the completed and signed form and documents to
KISC - Admissions in ‘Ilima 102. A copy of the member’s Military Orders must be submitted with this form.
Name of Applicant __________________________________________________________________________
UH Number/Username _______________________________________________________________________
The following section should be completed by the member’s Commanding Officer
1) ____________________________________________________________________________________
Name, rank & branch of service of active duty military member stationed in Hawai‘i, member of the Hawai‘i National
Guard, or Hawai‘i-based Reserves assigned to my unit or organization.
2) ____________________________________________________________________________________
Estimated date of rotation from Hawai‘i or separation from military service (whichever is earlier). Provide
month/day/year; do not use “indefinite”.
3) Member’s relationship to applicant (choose one):
 Self
 Spouse
 Parent
 Other (specify) ___________________________
Signature of Commanding Officer ______________________________________________________________
Printed Name of Commanding Officer ____________________________________________ Date __________
Rank and Branch of Service in Hawai‘i ___________________________________________________________
Phone Number of Branch of Service in Hawai‘i ____________________________________________________
Permission hereby granted to release information to UH Campus (attach Military Orders):
Applicant’s Signature ________________________________________________________________________
Military Member’s Signature __________________________________________________________________
Rev. 2/8/17
4303 Diamond Head Road ‘Ilima 102
Honolulu, Hawai’i 96816-4421
Telephone: (808) 734-9555
Facsimile: (808) 734-9896
Email:
kapadm@hawaii.edu
Website:
An Equal Opportunity/Affirmative Action Institution

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