University Of Hawaii-Maui-EOC-Application Form

Educational Opportunity Center Maui

Program Application 2021-2022

STEP 3 OF 9: Military-Affiliated
Military Status

Active DutyChild of Active DutySpouse of Active DutyVeteranNone

STEP 4 OF 9: Parent Education
Do either of your parents have a 4-year Bachelor's degree?*

YesNo
Identify which parent/legal guardian has a 4-year Bachelor's degree?*

Parent/Legal Guardian 1Parent/Legal Guardian 2BothNone

STEP 5 OF 9: Income Verification
What is the total number of persons (including you) in your family's household?*
What is your family's taxable (not total) income from the last calendar year? (Adjusted Gross Income)*
Form 1040 Line 15 OR write "Not required to file taxes" if you are not required to file taxes.

STEP 7 OF 9: Current Education Profile
High School (Check ONE)*

Graduated from High School.Earned my GED Diploma.Did NOT complete High School (specify highest grade completed below)Currently in a GED/High School Diploma Completion Program.
Highest grade level completed in High School
College (Check ONE)*

Never attended college.Attended college - did NOT complete. (specify number of credits earned below)Currently enrolled in college. (specify name below)Transfer College Student
Number of college credits earned OR name of college currently enrolled in

Other Program Involvement

	Answer
How did you hear about the TRIO Program?
Are you/were you a participant of another education-focused program?

STEP 9 OF 9: Read Below | Sign and Date
SERVICES: Support through all steps to apply and enroll in post-secondary education (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 post-secondary education.
PHOTO RELEASE: Unless I select to opt-out, I hereby grant the TRIO program and the University of Hawai'i 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 photographer from all claims and liability relating to said photographs (for example, the programs use student photos for brochures or promotional videos).

Optional OPT OUT if you do not agree for the use of photographs that include you.
PHOTO RELEASE: Unless I select to opt-out, I hereby grant the TRIO program and the University of Hawai'i 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).
Optional OPT OUT if you do not agree for the use of photographs that include you
HIGH SCHOOL & COLLEGE RECORD RELEASE: 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 TRIO 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 TRIO 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 TRIO programs permission to forward my information to other programs and/or departments within the University of Hawaiˋi System whose services will best meet my needs.

POST-SECONDARY VIRTUAL COUNSELING CONSENT: I, the parent or legal guardian understand my child may be interested in applying to an institution of higher learning. I authorize The Educational Opportunity Center and its officers, agents, and employees the right to discuss information related to college admissions and financial aid applications through remote services such as Zoom, Google Meet, and telephone.
Applicant Name*

First NameLast Name
Applicant Signature*

Clear
Date Signed*

MonthDayYear
mm-dd-yyyy
Students who answered "NO" to all of the dependency questions MUST have parent's signature on their application
Parent Name

First NameLast Name
Parent Signature

Clear
Date Signed

MonthDayYear
mm-dd-yyyy
This institution is an equal opportunity provider.

Important Notice: All Applicant information will be kept in strict confidence and not released.

310 W. Ka'ahumanu Ave. Kahului HI 96732
(808) 984-3286 | Email at eoc@hawaii.edu