University Of Hawaii-Maui-EOC-2024 High School Application Form

Educational Opportunity Center Maui Application

High School Program Application 2025-2026
- STEP 1 OF 9: PERSONAL INFORMATION
- Name*
  
  First NameMILast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Date of Birth*
  
  MonthDayYear
  mm-dd-yyyy
- Age
- Sex assigned at birth:*
  
  MaleFemale
- Student's home phone
  (999)999-9999
- Student's cell phone
  (999)999-9999
- Text Opt-Out
- Student's Personal Email - (Non-Highschool Email)*
  example@example.com
- STEP 2 OF 9: HIGH SCHOOL & EDUCATIONAL PLAN
- High School*
- Grade Level*
- What are your plans after graduating high school?
  
  Work Full-TimeMilitaryVocational School (ex: automotive, cosmetology, culinary, etc.)Associate’s Degree (2 year college program)Bachelor’s Degree (4 year college program)Graduate/Professional School (ex: Master’s Degree, PhD)Undecided about my educational plans after school
- My career choice(s) and/or major for college might be:
- First Choice
- Second Choice
- STEP 3 OF 9: ETHNICITY & CITIZENSHIP
- Ethnicity*
  
  African American/BlackAsian AmericanCaucasian/WhiteHispanic or LatinoNative American or Alaskan NativeNative HawaiianPacific IslanderOther
- Are you a U.S. citizen?*
  
  YESNO, but I'm a permanent resident.NO, I am not a U.S. Citizen, and I amnot a permanent resident.
- My Permanent Resident Alien Number is:*
- Citizen of?
  
  American SamoaFederated States of MicronesiaGuamRepublic of Marshall IslandsRepublic of PalauNothern Mariana Islands
- If English is NOT your first language, do you have a difficult time speaking, reading, and/or writing English?
  
  YesNo
- STEP 4 OF 9: FAMILY INFORMATION
- Parent/Guardian Name
  
  First NameLast Name
- Parent/Guardian Phone
  (999)999-9999
- Text Opt-Out
- Parent/Guardian Email
  example@example.com
- Do either of your parents that you regularly live with and receive support from, have a Bachelor's degree?*
  
  YesNo
- Identify which parent/legal guardian has a 4-year Bachelor's degree?*
  
  Parent/Legal Guardian 1Parent/Legal Guardian 2BothNone
- Are either of your parents on active military duty?
  
  YesNo
- Are you active military?
  
  YesNo
- Is your spouse active military?
  
  YesNo
- Do you have a documented disability?
  
  YesNo
- 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
  
  Not required to file taxes
- STEP 6 OF 9: DETERMINATION OF DEPENDENCY
  
  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.
- 1. Will you be 24 years of age or older before December 31?*
  
  YesNo
- 2. At any time since you turned 13, were you an orphan, in foster care, or a ward of the court?*
  
  YesNo
- 3. Prior to reaching 18 years of age, were you an emancipated minor or have a court-appointed legal guardian?*
  
  YesNo
- 4. As of today, are you married?*
  
  YesNo
- 5. Do you have children or dependents (other than spouse) who receive more than half their support from you?*
  
  YesNo
- 6. Are you homeless (i.e. you lack a fixed, regular, & inadequate night-time residence) or at risk of becoming homeless?*
  
  YesNo
- STEP 7 OF 9: CURRENT EDUCATION PROFILE
- Current Program Participant of
  
  Educational Talent SearchGEAR UPUpward BoundUpward Bound Math ScienceEducational Opportunity CenterOther
- How did you hear about the TRIO programs? Please be specific.
- STEP 8 OF 9: NEEDS ASSESSMENT
- How can we help you? Please check all the services you may want to use and/or need.
  
  Assisting with Applying to CollegeBudgeting & Personal Financial PlanningScholarshipsCollege Degree & Program Information/MajorTutoring/Academic SupportCollege Placement Test Tutoring and Preparation (Accuplacer, ACT, SAT, etc.)Assistance with Applying for Financial Aid (FAFSA)Career ExplorationInformation on GED Classes & TestingHigh School Course Selection to Meet College Requirements
- What additional challenges might keep you from going on to college or completing a college degree? Please check all that apply
  
  Ability to afford collegeUncertain of which college prep courses to takeUndecided about future careerNot sure if I can be successful in collegeNot able to visit colleges outside of MauiNo family member has attended collegeRigorous college prep courses are not available at my school and/or to meNot sure of the steps to take to pursue my career of interestNot sure if I will be accepted to collegeNone of my friends plan to go to college
- STEP 9 OF 9: READ BELOW / SIGN AND DATE
- 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 a parent's signature on their application. Students who answered "YES" to any of the dependency questions may answer the Parent Signature Section with "N/A"
- Parent Name
  
  First NameLast Name
- Parent Signature*
  
  Clear
- Date Signed
  
  MonthDayYear
  mm-dd-yyyy
- 310 W. Ka'ahumanu Ave. Kahului HI 96732
  
  (808)984-3286 | Email at eoc@hawaii.edu
  
  This institution is an equal opportunity provider.
  
  Important Notice: All Applicant information will be kept in strict confidence and not released.

Educational Opportunity Center Maui Application