JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Stay Maui Nui- Application - Summer 2024
Youth Career Exploration Program for Maui County Students.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Name (First and Last, Nickname)
*
Your answer
Which Program Week Session are you applying to?
*
Session 1 - June 10th through 14th - Maui residents only
Session 2 - July 8th through 12th - Molokai residents only
Session 3 - July 22nd through 26th - Lana'i residents only
Student Email
*
Your answer
Student Phone Number
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Email
*
Your answer
Parent Phone Number
*
Your answer
Physical Address where Student lives
*
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Grade in School at the Start of Fall 2024
*
9th grade
10th grade
11th grade
12th grade
Graduated in May 2024
School Student will be attending in Fall 2024
*
Baldwin High School
Kulanihakoi High School
Kamehameha Schools Maui
Kihei Charter High School
King Kekaulike High School
Lahainaluna High School
Maui High School
Seabury Hall
St. Anthony High School
Homeschooled
Molokai High School
Lanai High School
Other
Other:
Gender
*
Female
Male
Non-binary
Prefer not to answer
Has the Student taken a Career Assessment?
*
Yes
No
Maybe
If yes, the Student has taken a career assessment, what were the results, and does the Student like the results?
*
Your answer
What career paths are the Student interested in learning more about?
*
Your answer
What activities is the Student involved in, both in and out of school? Hobbies or Interests?
*
Your answer
Does the Student have allergies or dietary restrictions? If yes, please explain.
*
Your answer
Does the Student take any medications that we should be made aware of?
*
Your answer
Tell us about yourself (or of the Student) that will help in knowing your/Student needs.
*
Your answer
Do you or the student have any specific goals in participating in the Stay Maui Youth Program?
*
Your answer
Is the Student able to attend all the program meeting days and times? If not, please explain.
Mon-Thu 8:30am to 4:30pm and Fri 8:30am to 6:30pm
*
Your answer
Does the student have transportation to and from: the YMCA for Maui Students, Kaunakakai for Molokai students, or Lanai City for Lanai students?
*
Yes
No, transportation will be an issue.
Both the student and the student's Parent or Legal Guardian are aware of the submittal of this application?
Both Student and Parent knows this application is being submitted.
Neither Student or Parent knows this application is being submitted. (Youth service worker or School Counselor is submitting application.)
Just the Student knows this application is being submitted.
Just the Parent knows this application is being submitted.
Clear selection
How did you hear about the Stay Maui Program?
*
Stay Maui Nui program staff
A friend or family member told me about it
Facebook post
Instagram post
Ka Ipu Kukui website
Maui Family YMCA website
Attended Informational Meeting
Comments
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Stay Maui Nui.
Report Abuse
Forms
