Student Activity Fee Waiver Form

Student Activity Fee (SAF) waivers are for students who are taking ALL online courses at Hawai‘i Pacific University and reside off-island. As students who reside off the island of O‘ahu are unable to take advantage for the SAF funded activities, programs, resources, services and events, they may request a SAF waiver for consideration. Each waiver must be submitted each fall and spring semester.

Name Name First Last
HPU ID Number @
HPU Email (@my.hpu.edu)
Phone Phone - ### - ### ####
Current Address Current Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Status
Enrollment
Semester Request
Year Request
I am requesting that I be exempt from paying the Student Activity Fee for the stated term noted on this form as I am taking all online courses during the semester AND do not reside on the island of O‘ahu to take advantage of the SAF funded activities, programs, resources, services, and events.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY