Fillable Uh Kapiolani Community College Enrollment Verification Request Form printable pdf download

University of Hawai‘i  Kapi‘olani Community College

Kekaulike Information and Service Center (KISC)

4303 Diamond Head Road, ‘Ilima 102  Honolulu, Hawaii 96816‐4421

Phone: 808.734.9555  Fax: 808.734.9896  Email: kapinfo@hawaii.edu

ENROLLMENT VERIFICATION REQUEST FORM

Instructions: Please print and attach appropriate documentation and applicable forms (i.e. Stafford Loan

deferment forms, medical insurance, child support, etc.). Enrollment verifications will not be processed for

students with financial obligations (account balances or administrative holds) to the UH System. Processing time is

approximately three (3) business days after the receipt of this request.

Note: This enrollment verification request confirms course registration only and cannot confirm receipt of payment

nor attendance in courses.

I, (print name clearly) __________________________________________________________________, authorized

Kapi‘olani Community College to provide the information requested on this and/or the attached form(s) to the

party/parties named.

UH Number ____________________________________

Major ______________________________

UH Email ____________________________@hawaii.edu

Phone ( ) _______________________

Enrollment verification is requested for (choose all that apply):

 Spring _____________________ (year)

 Summer ____________________ (year)

 Fall ________________________ (year)

 Attached Agency form/documentation for _________________________________________

 Also include the following information ____________________________________________

 My expected date of graduation from Kapi‘olani CC is ________________________________

Delivery Method (choose one):

 To be picked up by: ____________________________________________________________

Note: Must present Photo I.D. upon pick‐up.

 Mail to: Name/Attn: ___________________________________________________________

Address:

_______________________________________________________________

 Fax to: Name/Attn: ____________________________________________________________

Organization: __________________________________________________________________

Fax Number: ( ) ___________________________________________________________

Student’s Signature ____________________________________________________ Date ____________________

FOR OFFICE USE ONLY

Received by/date: _________

SOAHOLD:  Yes  N o SGASTDN – KAP:  Yes  No

Term(s): ______________________________________________________________________________________________________________

Credits: ______________________________________________________________________________________________________________

Enrollment Dates: ________________________________________________ _ ________________________ Completed by/date __________

Rev. 06/13

Uh Kapiolani Community College Enrollment Verification Request Form