Mālamapōkiʻi Application SY 19 - 20
NOTE:  COPY OF APPLICANT'S BIRTH CERTIFICATE IS REQUIRED TO COMPLETE APPLICATION PROCESS.
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Application Priority Deadline:  Jan. 31, 2019
NON-DISCRIMINATION POLICY STATEMENT
It is the policy of Mālamapōkiʻi Early Childhood Education Program to maintain a working and educational environment free of all forms of unlawful discrimination. Mālamapōkiʻi affords equal opportunity to all individuals without regard to race, color, religion, national origin, sex, disability, age, or other criteria protected by law in its employment practices, educational programs, and activities. Inquiries regarding non-discrimination policies should be addressed to Nancy Levenson, Director at 887-1117.
Applicantʻs Legal First Name *
Applicantʻs Legal Middle Name *
Applicantʻs Legal Last Name *
Applicantʻs Preferred Name
Birth Certificate Number *
Sex *
Birthdate *
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Family 1 *
Family 1 Last Name *
Family 1 First Name *
Family 1 Mailing Address *
Family 1 City *
Family 1 State *
Family 1 Zip Code *
Family 1 Home Address *
Family 1 City *
Family 1 Zip Code *
Family 1 Email Address *
Family 1  Cell Number
Family 1  Home Number
Family 1  Occupation
Family 1  Employer
Family 2 *
Family 2  Last Name
Family 2  First Name
Family 2  Mailing Address
Family 2  City
Family 2  State
Family 2  Zip Code
Family 2  Home Address
Family 2  City
Family 2  Zip Code
Family 2  Email Address
Family 2 Cell Number
Family 2 Home Number
Family 2 Occupation
Family 2 Employer
Birth Parents' Status *
Living in Home *
Required
How may siblings (include "adoptive", "half", or "step" brothers/sisters) ? *
How many siblings attend Kanu o ka ʻĀina NCPCS? *
Did Parent(s)/Legal Guardian(s) attend Kanu? *
Did Parent(s)/Legal Guardian(s) graduate from Kanu? *
I/We hereby certify that the above statements are true to the best of my/our knowledge and agree to furnish proof and other documentation as requested.  I/We acknowledge that failure to disclose any requested information, or providing inaccurate information may result in the disqualification or disenrollment of my/our child.     By typing your name below , you are "Electronically approving and signing" this document. *
I/We hereby certify that the above statements are true to the best of my/our knowledge and agree to furnish proof and other documentation as requested.  I/We acknowledge that failure to disclose any requested information, or providing inaccurate information may result in the disqualification or disenrollment of my/our child.     Today's Date *
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