Non-Degree Seeking Application

Last Name

First Name

Middle Name

Birth Date

BYUH ID#

Gender

Male

Female

Marital Status

Single

Married

Religious Affiliation

LDS

Other

Semester Applying For

Mailing Address

City

State/Province

Zip Code

Country

Street Address is Same as Mailing Address?

Yes

No

Phone Number

Email

Please select the status that applies to you

Do you require special assistance?

Yes

No

Emergency Contact Full Name

Relationship to You

Emergency Contact Address

City

State/Province

Country

Zip Code

Email

Phone Number

Applicant's Commitment

I have read and discussed the BYU-Hawaii Honor Code with my ecclesiastical leader. I understand what the Honor Code is and what my obligations are. • I agree that the university may obtain confidential recommendations from church leaders and high school counselors concerning my application for admission and hereby waive any right I may have under university policies or federal or state laws to examine confidential recommendations received by the university. • I also agree to allow the university to supply information relative to my BYU-Hawaii academic or financial records to appropriate federal/state agencies or parents/guardians when needed. • I hereby certify all statements in this application are complete and true and acknowledge that my admission and my continuing status are conditional on such completeness and truthfulness. • I also understand that: - I will be held accountable to the same academic standards as degree-seeking BYU-Hawaii students, coming through admissions. - Non-degree seeking students are not eligible for: on-campus housing, student jobs at BYUH, student jobs the Polynesian Cultural Center or any other church entities, student medical insurance, university scholarships, Pell Grant or other Federal Government student loan programs. - Student’s ecclesiastical endorsement must be current during the time of their attendance at BYUH. The endorsement must be renewed and re-submitted every year prior to expiration. - Students are able to take up to 6 credit hours per semester. An approval via Educational Outreach is required if the amount of credits exceed the maximum. The tuition charge will be per credit and tuition benefit is available only for those who are full-time employees and their dependents whom are determined eligible by BYUH Human Resource Office (HR). It is the applicant’s responsibility to submit the form to HR Office at the beginning of every semester they attend. - Non-degree seeking students who wish to become an undergraduate degree-seeking student at BYUH must contact the office of Admissions to apply as a regular student. Caveat: Subject to Changes

I hereby confirm that I have read and understand the above statements

Citizenship

Birth Country

Visa Status

If other, please specify

Ethnicity

Do you have a CES NET ID?

Yes

No (If no, please create one)

Are you new to using BYU-H campus?

Yes

No

Have you attended CCH or Brigham Young University Institution (Provo, Hawaii or Idaho) in the past?

Yes

No

I am at least 18 years old

Yes

No

I am a resident of the state of Hawaii (Proof of residency required)

Yes

No

I have submitted a current copy of my ecclesiastical endorsement. (Not applicable to BYUH employees)

Yes

No

I am currently on academic suspension from BYU-Hawaii

Yes

No

I am currently on an Honor Code suspension from BYU-Hawaii

Yes

No

I am currently on probation with, disfellowshipped or excommunicated from, or voluntarily disaffiliated from the Church of Jesus Christ of Latter-day Saints. (Applicants are inadmissible until reinstated to full fellowship.)

Yes

No

I am affiliated with a church or other religious group that advocates the current practice of plural marriage.

Yes

No

I am current on probation, parole, or under restriction with any court, or have ever been convicted of a crime(other than a traffic violation).

Yes

No

I already have a bachelor's degree and understand I am required to provide a copy of my diploma as part of my application.

Yes

No

Math question 4 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Non-Degree Seeking Application - NEW STUDENTS