Fillable ParentInformation University of Hawaii at Hilo

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ParentInformation University of Hawaii at Hilo

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PARENT INFORMATION
Upward Bound Program University
of Hawai‘i at Hilo
Parent 1 / Legal Guardian
LAST Name: _______________________________ FIRST Name: ________________________________ MI:__________
Mailing Address: __________________________________ City: _________________ State: __________Zip: __________
Home Address: __________________________________ City: _________________ State: __________Zip: __________
Home Phone: (______) _______-_______ Cell Phone: (______) _______-_______ Alternate: (______) _______-_______
Email Address: ______________________________________________________________________________________
Place of Employment: __________________________________________ Occupation: ____________________________
Relationship to Student: _______________________________________________________________________________
Parent 2 / Legal Guardian
LAST Name: _______________________________ FIRST Name: ________________________________ MI:__________
Mailing Address: __________________________________ City: _________________ State: __________Zip: __________
Home Address: __________________________________ City: _________________ State: __________Zip: __________
Home Phone: (______) _______-_______ Cell Phone: (______) _______-_______ Alternate: (______) _______-_______
Email Address: ______________________________________________________________________________________
Place of Employment: __________________________________________ Occupation: ____________________________
Relationship to Student: _______________________________________________________________________________
1. Who does the applicant live with?
Mother Grandmother Uncle other: ___________________________
Stepmother Grandfather Aunt
define relationship
Father Foster Parent Legal Guardian
Stepfather Hanai Parents Family Friend
2. Check the highest level of education attained Parent 1 Parent 2
Professional Degree (ie. Doctor, Lawyer,PhD)
Master’s Degree
Bachelor’s Degree
Associate Degree/2yr. Certificate
Some College Experience
High School Diploma/GED
Did not complete High School/GED
3. If either parent has a college bachelor’s degree or higher please answer the following, otherwise leave blank.
From what college did you receive your degree/certificate?
Parent 1: _________________________________________________________________________________________
Parent 2: _________________________________________________________________________________________
What was your course of study?
Parent 1: _________________________________________________________________________________________
Parent 2: _________________________________________________________________________________________
4. Do you receive any of the following: Check all that apply.
Social Security Welfare Disability Veterans Benefits General Assistance None
5. How many family members live in your household? 1 2 3 4 5 6 7 8 9 10
• I understand the information the applicant and parent provide will be used to determine if the applicant is eligible for
college preparatory services funded by the U.S. Government
• I understand that information provided will be kept secure and confidential
• I understand that I may need to provide information updates as necessary
• I understand the applicant will be released from Upward Bound if he/she does not make earnest effort to meet
Program academic and behavior standards, and abide by Program rules, University of Hawaii policies and, state and
federal laws
• I understand that the applicant will be denied admission or released from Upward Bound if information provided is
not true and accurate to the best of the applicants and parent’s knowledge
• I understand that deliberate misrepresented information is prosecutable under federal law
Student Signature: __________________________________________________________
Parent /Legal Guardian Signature: _____________________________________________
Submit completed applications:
By Mail:
University of Hawaii Hilo
Upward Bound Program
200 W. Kawili Street
Hilo, Hawaii 96720-4091
Drop Off:
University of Hawaii Hilo Building 346 - Ground Level
11/20/18
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ParentInformation University of Hawaii at Hilo

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Completed 1 March 2020

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