Puʻuhonua ʻO Ka ʻUlulehua Intake Questionnaire
Mahalo for your interest in our program. Please complete the following intake
form. Information is collected for grant purposes.
Email *
Email *
Phone Number *
What's the best way to reach you? (phone or email)
 *
Name (Legal) *
Name (Preferred) *
What Races/Ethnicities do you identify with?
 *
Are you Hawaiian? *
If you are not Kānaka Hawaiʻi, why are you interested in joining our Puʻuhonua?
Gender (Self-Identified)
 *
Do you identify as Transgender?
 *
Where do you reside? (City, Island) 
 *
Family size
 *
Do you have any Hawaiian Children? *
If you answered yes, how many Hawaiian children do you have?
Why do you want to participate in this program?
 *
What do you hope to gain from it?
 *
Please select your support needs: *
Required
What is your proficiency in Hawaiian Language and Culture?
 *
Low Proficiency
High Proficiency
What days of the week are you available for program activities?
 *
Required
What program times work best for you? (Check all that apply)
 *
Required
Are you interested in taking Papa Oli classes via zoom on Mondays from 7-8pm March 11, 2024 to May 27, 2024?
 *
How interested would you be in participating in the following cultural activities? *
1 (Not Interested)
2
3 (Moderately Interested)
4
5 (Very Interested)
Oli (Chant)
Mele (Singing)
Mālama ʻĀina (Caring for the Land)
Hiking
Cultural Education
Moʻolelo (Storytelling/History)
Kamaʻilio
Weaving
Kapa Making
Is there any cultural knowledge that you would be willing to share with the group?
Is there anything else you would like to share?
Submit
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