QUALITY CARE FOR HAWAIIAN KEIKI REDETERMINATION APPLICATION SUBMISSION

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* 1. Contact Information

Parent/Caregiver Name

Email Address

Phone Number

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* 2. STEP 1: Complete this application IN FULL. Be sure to SIGN AND DATE the completed application.

STEP 2: Collect all Required Documents.

STEP 3: Submit your application and documentation as instructed below.

*MAXIMUM FILE SIZE TO UPLOAD IS 16MB. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILES AND UPLOAD THEM IN SECTIONS BELOW.

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* 3. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 4. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 5. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 6. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 7. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 8. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 9. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.

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* 10. UPLOAD FORMS BY CLICKING CHOOSE FILE AND LOCATING COMPLETED FORMS ON YOUR DEVICE/COMPUTER. YOU MAY NEED TO SEPERATE YOUR DOCUMENTS INTO SMALLER FILE SIZES.