Fee Collection Form

Please print out this form now, fill it out and send it in, with payment, to:

E-School - ATR
475 22nd Ave. Room 211
Honolulu, HI 96816
Please make payment to:   Department of Education

If you have questions or concerns, please phone call us at 733-4777.

Please Print

I realize that this E-School course I am signing up for is a real course and this grade will appear on my transcript even though it may not appear on my school report card. If I chose to not continue this course, I must drop by the official drop date or I risk the chance of receiving an "F" on my permanent record.

Hawaii Department of Education E-School utilizes the latest technologies to support student learning needs. As part of the many technological applications employed across the curriculum, we publish exemplary teacher and student work to demonstrate learning in this new environment

I hereby give permission for my child's work, which may or may not be accompanied by the child's name and photo, to be electronically displayed and produced by E- School, and hereby release the State of Hawaii Department of Education from any liability resulting from or connected with the publication of such work.


Student's Name:





Parent's Name:







Parent's Signature
Date



Each .5 credit course is charged a fee of $80.00

Courses Taken
Course Fee

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TOTAL FEE

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