DETERMINATION OF DEPENDENCY STATUS

The following questions pertain to the student applicant. If you answer “Yes” to any of the questions below, the Income Verification section will be based on your (the student’s) income information. If all responses are “No”, the Income Verification will be the parent’s information and the application will need to be signed by both the student applicant and the parent and/or guardian. (If you answer Yes to any of the Determination of Dependency Status questions, when you get to the Parent/Guardian Name and Signature areas at the end of the form, please put N/A.)

Ethnicity

INCOME VERIFICATION

The majority of TRIO students must meet income requirements (students may qualify through other criteria). Documentation of income is required by the federal government in order to receive program funding. All applicant information is kept in strict confidence and not released.

***Taxbale income can be found on the 2023 IRS 1040 form on line 15***

OR

A copy of this final box of the form may be sent to secondary schools and/or colleges for release of transcripts, grades, records, test scores, status of student, and degrees earned. The Upward Bound programs are required to provide an annual report to the U.S. Department of Education with data obtained from individual student records, which allows for the continuation of funding to offer free student services. As such, we, the undersigned, authorize the release of official and/or unofficial documents reporting grades, test scores, student status, other academic records, and college majors/degrees to the Upward Bound programs at the University of Hawaiˋi Maui College valid from the date below until six years post high school graduation. I understand that the information in these records will only be used to assess the student's need for program services, evaluate the effectiveness of program activities, and fulfill federal program-reporting requirements. Furthermore, I hereby give the Upward Bound programs permission to forward my information to other programs and/or department with the University of Hawaiˋi System whose services will best meet my needs.

By signing, I attest that the information on this application is accurate and agree to the High School & College Record Release

(If you answered Yes to any of the Determination of Dependency Status questions, please put N/A in the Parent/Guardian Name and Signature areas.)