State Kaiapuni Distance Learning Program- Maui Intake Form
E hoʻopihapiha i kēia palapala noi komo no kēlā me kēia keiki.  Na ka Papahana Keleaʻo Kaiapuni e hoʻolako aku i ka ʻenehana e pono ai no nā haumāna i hoʻokō i nā koina a pau no ia papahana.

Please fill out a separate application for each child. The State Kaiapuni Distance Learning Program will provide a device for any student who has completed the full enrollment process for this program.
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Ka Inoa Mua o ka Haumana (Student's First Name) *
Ka Inoa Hope o ka Haumana (Student's Last Name) *
Ka Papa (Current Grade Level) *
Ka Inoa o ke Kula (Home-based School) *
He aha nā kākoʻo a ka haumana?  E kaha i nā mea a pau e pili. (What supports are the student receiving?  Check all that apply.)
Ka Inoa Mua o ka Makua/ke Kahu (Parent/Guardian First Name) *
Ka Inoa Hope o ka Makua/ke Kahu (Parent/Guardian Last Name) *
Ka Helu Kelepona (Contact Phone Number for Parent/Guardian)

Format: XXX-XXX-XXXX (i.e., 808-123-4567)
 *
Ka Helu Leka Uila o ka Makua/ke Kahu (Contact Email for Parent/Guardian) *
E hōʻike mai i ka paʻa a paʻa ʻole o ka pūnaewele iā ʻoe. (Do you have access to reliable internet?  If not, are you able to access the internet if a mifi device is provided?) *
E hōʻike mai i kekahi ʻikepili hou aʻe e kōkua ai. (Additional relevant information. e.g. special circumstances with guardianship- please provide contact information for any additional guardians, etc.)
Inā he nīnau (If you have any questions)
E kelepona mai ma ka helu 808-518-5364 a i ʻole e leka uila mai iā mākou ma keleao-kaiapuni@k12.hi.us

Please call 808-518-5364 or email us at:  keleao-kaiapuni@k12.hi.us for the State Kaiapuni Distance Learning Program.

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