Lunalilo Scholars Program 2017-2018 Referral Form

For help in completing this form, or for more information about this program, please contact the director, LaVache Scanlan, at or (808) 734-9371. If you do not receive an email response acknowledging your completion of this referral form, please contact the director immediately.

    Technical Issues

    This is a google form and will not save your progress. If you do not have a reliable Internet connection, you may lose your work if you leave the form inactive before reaching the end. We apologize in advance if you experience difficulties. A paper form is also an option and can be found at You have the option of editing your responses at the end of the referral form.


    The Lunalilo Scholars Program at Kapi`olani Community College is a unique program whose mission is to provide opportunities for transformative college experiences for students who have not considered higher education as a viable alternative because of financial or other barriers limiting college access. Through scholarship, academic and personal support and a sense of community, students will build a foundation for success in the first year of college as measured by student engagement, learning, and achievement.

    Notice to Referrer

    To be considered, the applicant must have a completed referral form. By submitting the following referral, you are helping our committee determine the applicant’s eligibility for the program. Thank you for taking the time to complete this referral form on the applicant’s behalf. Applicants must be O'ahu residents and have a high school diploma or will complete a GED by August 2017 to submit an application. Students accepted into the program must be a state resident as determined by the University of Hawai'i System Application Form and be enrolled at KCC for the 2017-2018 academic year. Applicants DO NOT need to apply to KCC before being accepted into the program. In order to receive this scholarship, applicants must be living on ‘Oahu for the 2017-2018 academic year. Students cannot commute from the neighbor islands and/or take all classes online with this scholarship. If accepted into the program recipients are REQUIRED to attend a program orientation in June (TBD) and the 10-day Summer Bridge Program (3 college credits) from July 24 - August 4, from 8:00am - 4:30pm daily (except weekends). If you do not receive an email response acknowledging your completion of this referral form, please contact us immediately. There could have been an error in submitting your form.


    The deadline to submit the online referral form is 11:59pm on Friday, June 2, 2017. Referrals submitted online after June 2, 2017 will only be considered for the wait list. A paper referral form may also be submitted. If a paper referral form is submitted, it must be postmarked by June 2, 2017. Applications submitted without a referral form will NOT be considered.