UH Mānoa Community Health Scholars Application Form

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Personal Background

First Name *

Last Name *

Date of Birth *

YYYY

Sex *

Female

Male

Prefer not to say

Other:

Phone Number *

Please format your phone number as the following: 808-956-5753

Home Address *

Include: Street Name and #, City, State, and Postal/Zip Code

Email Address *

Were you formerly placed in the foster care system in the state of Hawai'i? *

Yes

How did you hear about this summer program? *

Check all that apply

High School Counselor

High School Teacher

Coach

Relative

Friend

Other:

Required

Race/Ethnicity

Are you Hispanic/Latino? *

Yes

Select one or more of the following racial categories to describe yourself *

Check all that apply

American Indian/Alaskan Native

Black or African American

Caucasian or White

Asian

Native Hawaiian or Pacific Islander

Required

Select one or more of the following ethnic categories to describe yourself

Check all that apply

Chinese

Filipino

Japanese

Korean

Laotian

Vietnamese

Thai

Other Asian

Other:

Select one or more of the following ethnic categories to describe yourself

Check all that apply

Chamorro/Guamanian

Native Hawaiian

Micronesian

Samoan

Tongan

Other Pacific Islander

Other:

Educational Background

Current Grade Point Average (GPA) *

Your high school transcript will need to be emailed to tagordam@hawaii.edu to confirm your GPA

Will you be the first in your family to go to college? *

Yes

Maybe

What grade will you be in the Fall 2023 semester? *

High School Junior

High School Senior

University of Hawai'i Student

Other:

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