Application & Forms

Motivated individuals are encouraged to apply. Priority is given to those currently employed and to long-term residents.

Download and fill out the application form (PDF format)

Mail to or drop off at:
Ho`omoana Foundation
33 Lono Avenue, Suite 230
Kahului, HI 96732

You may also fax your application:
Fax: 808.877.7721

If you prefer E-mail our address is:

Mental Health Directive

Download the directive (Word format)

Download the Hawaii Q&A (Word format)

1. Fill out form and make a copy. You may make more copies and give to agents/case manager, anyone who will support you while you are in an episode.

2. Take one to medical records department at Maui Memorial Medical Center next to the Emergency Room and ask to have this put in your chart. If you do not have a chart, ask to have one started. Get the name of the person with whom you speak, write down the date and time.

3. Keep a copy.

4. Make sure any time there are phone number changes or an agent is changed that you update this information at the medical records department. Please keep track of whether or not the procedure is followed and let your case manager know.

Questions? Please call us:
Phone: 808.877.7720