Home Address:____________________________________________________________________________
Street Address and Mailing Address if different City State Zip Code Island (if applicable)
Address while attending UH Hilo: ________________________________________________________________
Street / Mailing Address City State Zip Code
Please circle residence hall (if applicable): Hale Kanilehua – Hale Kauanoe – Hale Kehau – Hale ‘Ikena
Phone Numbers: Home: ___________________ Cell: __________________ While @ UH Hilo: ____________
Email Addresses: __________________________________________________________________________
Citizenship: U.S. ____ Permanent Resident Alien ____ Other ________________
(Specify)
Ethnic Background - Please List All You Identify With (e.g. Hawaiian, Filipino, Samoan, Chuukese, etc.)
______________________________________________________________________________
What is your first language? _______________________ Marital Status ___________________
Did either of your parents earn a four-year college degree? Yes _____ No _____
Are you a transfer student? Yes ____ No ____ Do you plan to attend? Full-time ____ Part-time ____
Were you a participant in Upward Bound? Yes ____ No ____ If so, when? _____________________________
Please list the last High School and any post-secondary institutions you’ve attended, other than UH Hilo.
Institution
Location Dates Attended
__________________________________________________________________________________________
__________________________________________________________________________________________
(Use reverse side if necessary)
Major: _________________________ Career Interest: ________________________________
Have you applied for financial aid? Yes ____ No ____ Have not been notified yet ____
Please return the completed form to: University of Hawai‘i at Hilo
Minority Access & Achievement Program
200 W. Kawili St.
Hilo, HI 96720-4091
