Please fill out the information below to have a Hawaiian Ancestry Registry (HAR) form mailed to you.  You may enter a single dash (-) in a name field if required, but no other special characters are allowed.  Required fields are noted with an asterisk.*
Applicant   
First Name:*

 

Middle Name:*

 If no legal middle name, check here
Last Name:*
Suffix:

Maiden Name:
Gender:*
Date of Birth:* Month:
 Day:
 Year:
SSN (Last 4 digits only):     XXX-XX-
   Why are we requesting a Social Security Number?Sharing your social security number is optional, but providing it helps to uniquely identify you in cases where others have the same or similar names and birth dates. Please review our privacy practices by clicking on the Statements of Privacy, Copyright, & Disclaimer link located at the bottom of the page.
Parent or Legal Guardian Contact Information(Required for Minors)- US Click here for International Address
First Name:*   Last Name:*
Address Line 1:*
Address Line 2:
City:* State:*

Zip Code:*

 (XXXXX for US Zip Code)

Email:

 
Phone Number with Area CodePlease provide at lebers)
Primary Phone:*

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Program Applying To (select no more than 5)




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