University Of Hawaii-Maui-UB

UH Maui College TRIO Upward Bound Program Application
- Student's Name
  
  First NameMILast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Student's Cell Phone (if applicable)
  (999) 999-9999Format: (000) 000-0000.
- Student's Email
  example@example.com
- Parent/Guardian's Name
  
  First NameLast Name
- Parent/Guardian's Home Phone
  (999) 999-9999Format: (000) 000-0000.
- Parent/Guardian's Cell Phone
  (999) 999-9999Format: (000) 000-0000.
- Please check who we may text:
- Parent/Guardian's Email
  example@example.com
- Student's Date of Birth
  
  MonthDayYear
  mm-dd-yyyy
- Student Age
- Gender
- Do one or both of your parents that you regularly live with and receive support from have a Bachelor's degree (4-year college)?
- Do you have a parent on active military duty?
- Do you have a documented disability?
- High School
  Name of High School
- Grade Level
- What year do you expect to graduate from high school (for example, 2027)?
- Current GPA
- Cumulative GPA
- Please check the math classes you have completed/passed:
- UB/UBMS: Please attach current high school transcript (EOC/ETS does not require transcripts).
  
  Browse Files
  
  Cancelof
- What are your plans after graduating high school?
- My career choice(s) and/or major for college might be: (First Choice)
  First Choice Career
- Second Choice
  Second Choice Career
- Are you a current participant in any of the following federally funded educational programs?
- 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.)
- At any time since you turned 13, were you an orphan, in foster care, or a ward of the court?
- Prior to reaching 18 years of age, were you an emancipated minor or did you have a court-appointed legal guardian?
- As of today, are you (the student applicant) married?
- Do you, the student, have children or dependents (other than spouse) who receive more than half their support from you?
- Are you homeless (i.e. you lack a fixed, regular, & adequate nighttime residence) or at risk of becoming homeless?
- Ethnicity
- Ethnic Background
- If English is NOT your first language, do you have a difficult time speaking, reading, or writing English?
- U.S Citizen?
- Please provide your Alien Registration #A
  Alien Registration #A
- OR
- Citizen of:
- 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***
- What is the total number of persons, including you and your spouse, in your family’s household?
- What was the family’s taxable income (not total income) from last calendar year? ($)
  Family's Taxable Income
- OR
- Check if applicable:
- How did you hear about the Upward Bound programs? Please be specific.
- **Eligible students will be selected for one TRIO program. Please rank your interest at this time between the following TRIO programs (1-first choice, 2-second choice, 3-third choice). All program services and trips are at no cost to students:
- EDUCATIONAL TALENT SEARCH (ETS), 808-984-3723. GRADES: 6-12; SERVICES: Promote academic success through tutoring/mentoring, career exploration, college information (e.g., affording college, finding & applying to college, applying to scholarships/financial aid), and in-state college tours. PARTICIPANT EXPECTATIONS: Attend 2-4 activities per year, respond to advisor contact/calls, Attend after school tutoring if GPA is < 2.5 or D’s/F’s, participate in a 2-week summer program (career/college focused), apply and enroll in college.
- UPWARD BOUND (UB)/UPWARD BOUND MATH AND SCIENCE (UBMS), 808-984-3299. GRADES: 9-12; SERVICES: Promote academic success through tutoring, mentoring, & summer program, career exploration, college information (e.g., affording college, finding and applying to college, applying to scholarships/financial aid), and in-state/mainland college tours. PARTICIPANT EXPECTATIONS: Attend monthly Saturday workshops, attend after school tutoring if GPA is < 2.5 or D’s/F’s, meet weekly with UB/UBMS advisor at school, participate in a 6-week summer program (academic focus), apply & enroll in college, and maintain contact with UB/UBMS while in college.
- EDUCATIONAL OPPORTUNITY CENTER (EOC), 808-984-3286. GRADES: 12; SERVICES: Support through all steps to apply and enroll in college (college exploration, college match, financial aid/scholarship application completion, etc.). This program is for seniors and/or students who are primarily interested in several appointments rather than ongoing educational, cultural, and recreational activities. PARTICIPANT EXPECTATIONS: Meet with EOC advisor, complete financial aid forms, apply, and enroll in college.
- How can we help you? Please select all the services you may want to use and/or need.
- What additional challenges might keep you from going on to college or completing a college degree? Please select all that apply
- What is your motivation to join the Upward Bound programs (i.e. why are you interested in this program, why should you be selected)?
- PHOTO RELEASE: Unless I select to opt-out, I hereby grant the Upward Bound program staff and the University of Hawaiˋi Maui College the right to use and publish photographs of me, or in which I may be included, for editorial trade, advertising, and any other purpose and in any manner and medium, and to alter the same without restriction. I hereby release the photographer from all claims and liability relating to said photographs (for example, the programs use student photos for brochures or promotional videos).
- 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.)
- Student's Name
  
  First NameLast Name
- Student's Signature
  
  Clear
- Date Signed
  
  MonthDayYear
  mm-dd-yyyy
- Parent/Guardian's Name
  
  First NameLast Name
- Parent/Guardian's Signature
  
  Clear
- Date Signed
  
  MonthDayYear
  mm-dd-yyyy