HWST 194: Hawaii Sustainable Development Goals 2 - Student Application Form
You will NOT be able to save your work and return to finish the application later. Incomplete applications will not be considered.

Please only begin this form once you have:
- gathered all the required materials
- have a parent present to complete the last section of this application form
- carefully read the course description, requirements, and eligibility at www.paachawaii.org/SDGC

Application materials must be submitted by midnight on Friday, April 16, 2021.
Sign in to Google to save your progress. Learn more
Email *
Information about the Student Applicant
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Which gender do you identify with? *
Email address (we prefer a Gmail address instead of a school-based email address. Some school-related addresses block messages from PAAC.) *
Current school *
Only public high school students are eligible to take this course. Unfortunately, we are unable to accept students who attend private, charter, or home school at this time.
Grade in high school *
Only students in grades 10 and higher are eligible to take this course at this time.
Cell phone number (or home phone if you do not have a cell phone) *
Address (only your town and island needed - e.g. Kalihi, Oahu) *
Write the full name, phone number, and email address of your school counselor. *
List any health or medical conditions or restrictions program organizers should know about that could impact your participation in an online class. *
Are you a highly proficient English-speaker?
Clear selection
Do you have Native Hawaiian ancestry?
Clear selection
Are/were you eligible for free or reduced-cost lunch at school last school year?
Clear selection
Describe any previous PAAC involvement you have had (study tour, GLP, GVS, class, club). If none, please leave this question blank. *
Required
How did you hear about this opportunity (check all that apply) *
Required
Are you considering attending the University of Hawaii after you graduate high school?
Clear selection
Course Related Questions
Please explain your motivation for participating in this course. *
What global issues are you most interested in and why? *
What local (Hawaiʻi) issues are you most interested in and why? *
What other opportunities have you had (in or out of school) to learn about global issues and the world? *
Do you have regular access to strong internet connection and a device capable of web conference calling (with video) for the entire semester? *
Are you available for Group A *and* Group B discussion sections? If not, please explain your pre-existing commitments for either section under "other" below. *
See the course website for details on class times. All class sessions are mandatory and attendance will be counted in determining your course grade. If there are fewer than 20 students enrolled in the class, we will not have a Group B, rather the entire class will meet on Mondays, Wednesdays, and Fridays.
Are you able to independently manage and complete assigned coursework and projects without constant reminders from the instructor? *
Will you uphold the University of Hawaii-Hilo Student Conduct Code in the class - including academic integrity and maintaining a safe class environment for all? *
Will you be responsible for reaching out as early as possible to the instructor for help if you are having trouble in the class? *
Do you foresee any difficulties participating in online, virtual meetings? If so, please specify here. *
Please specify any challenges you think you might encounter with difficulties related to virtual learning, such as poor internet connection at home, no home computer or tablet, lack of access to a quiet space, etc. If you do not anticipate any issues, please write N/A.
What other commitments do you have that might interfere with this course? *
If you are selected, you are expected to prioritize this course over other obligations. Consistent absences or late work will negatively impact your grade.
List any extracurricular activities and programs are you involved in at least twice a month. *
Are you taking / have you taken an Early College course through the University of Hawai'i system? *
If you replied "yes" to the previous question, list what Early College courses you have taken and where you took them. (For example: ENG 100 - Leeward Community College)
If you already have a UH email address (ends in "hawaii.edu") please type it here.
If you already have a University of Hawai'i student ID number, please type it here.
Have a counselor or school registrar send your transcript (a scanned image or electronic file) to paac@paachawaii.org or mail it to PAAC offices (address in application instructions). Type yes to indicate you will do this so that the transcript arrives before April 16.
Online Teacher Recommendation Form
Have a teacher complete this online Teacher Recommendation Form by midnight on April 16, 2021:
https://forms.gle/LPY8az61MgtWGzPx8

For the Student Applicant
By typing my name below and submitting, I certify that all information provided in this application is true.  Should any discrepancies come to light, I understand that my application will be discarded.  
Student Name *
Today's Date *
MM
/
DD
/
YYYY
FOR PARENTS AND GUARDIANS
The following section should be completed by the applicant's Parent or Guardian.
Parent or Guardian's Name *
Parent or Guardian's Relation to Student *
Parent or Guardian's Phone Number *
Course instructors may reach out to you via phone call or email if we have questions or concerns about a student's performance in the course, or in case of an emergency.
Parent or Guardian's Email Address *
Parental/Guardian Consent for Student Participation
Please read the following statements and sign by typing your name below.

Information Sharing between PAAC and the University of Hawai'i
I/we hereby give permission for my child to participate in the course: Hawaiian Studies 194 - Hawai'i Sustainable Development Goals II, offered by the Pacific & Asian Affairs Council (PAAC) and the University of Hawaiʻi at Hilo (Ka Haka ʻUla ʻO Keʻelikōlani College of Hawaiian Language and ʻImiloa Center). By completing this application, I/we consent that the information submitted in this application, along with information from school records, teachers, counselors or deans can be used in determining my/our child’s suitability for this program and can be shared amongst course administrators and instructors, including PAAC and the University of Hawaii at Hilo including Ka Haka ʻUla ʻO Keʻelikōlani and ʻImiloa Center. I/we further acknowledge that PAAC and UH Hilo reserve the right to select participants for this course at their discretion.

Communication
I understand that PAAC will provide information regarding the course to my child via digital documents, email, and web conference meetings. It is the responsibility of my child to inform me of the dates and requirements for the course and these meetings.

Liability
I expressly waive any and all claims against PAAC, the University of Hawaii, and the Department of Education (DOE), their respective board members, employees, agents, representatives and successors, arising from or in connection with any accident, injury, illness, or other damage that may be incurred by my/our child or his/her property in connection with or incident to his/her participation in this course or other PAAC activities.

Media Release and Waiver
I/we authorize PAAC and the University of Hawaii to:
a) Record my/our child's participation and appearance in the course and related PAAC events on videotape or audiotape, in photographs, or in any other recorded medium. I/we understand that these recordings may be used in any medium, including print, Web, video, or audio.
b) Use my/our child's name, likeness, voice, and biographical material in connection with recordings.
(c) Exhibit or distribute such recording in whole or part without restrictions or limitation for any educational or promotional purpose which PAAC and the University of Hawaii deem appropriate. I/we waive any right I/we might have to inspect and/or approve the finished medium, or the use to which it may be applied. I/we have read and fully understood the above paragraph and am knowingly and voluntarily executing this release without compensation.
Parent/Guardian Signature *
By typing my name, I certify that I am the parent/guardian of the student whose information is listed in this application and I agree to all of the above statements in the "Parental/Guardian Consent" section. I understand that I will receive a digital copy of this form and application and can contact the course instructors with questions or concerns.
Today's date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Pacific & Asian Affairs Council. Report Abuse
Google Forms