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QUALITY CARE FOR HAWAIIAN KEIKI REDETERMINATION APPLICATION SUBMISSION
*
1.
Contact Information
(Required.)
Parent/Caregiver Name
Email Address
Phone Number
*
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.
(Required.)
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 AND USE THE OTHER FILE UPLOAD BOXES PROVIDED BELOW. MAXIMUM FILE SIZE FOR EACH UPLOAD IS 16MB.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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.
Choose File
No file chosen
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