HONOLULU PY2023-2024


Mahalo for applying for our WCC TRiO Educational Talent Search program!

WCC TRiO Educational Talent Search is federally funded by the United States Department of Education. *PREFERENCE is given to students whose family income does not exceed guidelines established by the federal government and/or whose natural or adoptive parent(s) have not earned a four-year college/university degree. The Privacy Act protects the personal information given to WCC TRiO Educational Talent Search. The U.S. Department of Education has the authority to gather such information (20USC 1231a) and is required to determine program eligibility. Information is confidential and will NOT be reported by individual student and/or family.


Part I: STUDENT INFORMATION
Legal Last Name *
Legal First Name *
Legal Middle Name(s)
Current School *
Current Grade Level *
Date of Birth (MM/DD/YYYY) *
Current Age *
Assigned Gender at Birth *

ETHNICITY (CHECK ALL THAT APPLY)
Hispanic or Latino
Native Hawaiian
Pacific Islander
American Indian or Alaskan Native
Black or African American
Asian
White

CITIZENSHIP
Citizenship *

CHECK ONLY IF English is a SECOND language

PERMANENT MAILING ADDRESS & CONTACT INFO
Street Address (include Apt./Unit #)/ PO Box *
City *
State *
Zip Code *
Phone (Student Cell/Primary Contact)- *If student does not have own cell number, please provide parent/legal guardian cell number. *If student and/or parent does not have a cell number, please provide a phone number for the closest relative/friend who can reach you in case of an emergency. *
Non-School Email (Student) *If student does not have their own personal email, please provide a parent/legal guardian email that you will be checking regularly. *
Instagram (IG) OR other social media account usernames? (List multiple, if applicable)

Part II: (PARENT A) INFORMATION

*Parent/Legal Guardian who the student currently lives with and can be contacted regarding program information and/or in an emergency.

First AND Last Name *
Contact 1 Relationship *
Cell Phone *
Email *
Do you have a Bachelor's Degree or higher (from a college/university in the U.S.)? *
Name of College/University where Bachelorʻs Degree was attained

(SKIP SECTION, IF NOT APPLICABLE)

Part II: (PARENT B) INFORMATION

*Parent/Legal Guardian who the student currently lives with and can be contacted regarding program information and/or in an emergency.

First AND Last Name
Contact 2 Relationship
Cell Phone
Email
Do you have a Bachelor's Degree or higher (from a college/university in the U.S.)?
Name of College/University where Bachelorʻs Degree was attained

PART III: HOUSEHOLD INFORMATION

*PREFERENCE is given to students whose family income does not exceed guidelines established by the federal government and/or whose natural or adoptive parent(s) have not earned a four-year college/university degree. The Privacy Act protects the personal information given to WCC TRiO Educational Talent Search. The U.S. Department of Education has the authority to gather such information (20USC 1231a) and is required to determine program eligibility. Information is confidential and will NOT be reported by individual student and/or family.

The studentʻs current primary residence is with: *
Total Number in Household *in the primary household where the student resides majority of the year. *
Were you required to file federal tax forms for 2022 income? *
2022 Taxable Income Range *
2022 Taxable Income (IF OVER $87,210)

PART IV: ADDITIONAL STUDENT INFORMATION

*PREFERENCE is given to students whose family income does not exceed guidelines established by the federal government and/or whose natural or adoptive parent(s) have not earned a four-year college/university degree. The Privacy Act protects the personal information given to WCC TRiO Educational Talent Search. The U.S. Department of Education has the authority to gather such information (20USC 1231a) and is required to determine program eligibility. Information is confidential and will NOT be reported by individual student and/or family.

Does the student receive FREE lunch? *
The student is an orphan, in foster care, or a ward of the court? *
The student is homeless or at risk of becoming homeless? *
Is the student is an emancipated minor or does he/she have a court-appointed legal guardian? *

PART V: TRiO ETS Services

I would like help/support in the following areas (CHECK ALL THAT APPLY):

Tutoring for some of my classes/subjects.
Choosing the right high school courses (that will align with my career/college requirements) (College/Career Planning)
Researching jobs/careers that match my interests/skills/personality (Career/Self-Awareness)
Learning about jobs/careers (Career Exploration)
Learning life and work skills (Career and Life Skills)
Learning how to save, budget, and manage my money (Financial Literacy)
Learning about colleges (College Awareness)
Visiting colleges, college fair, career tours, etc. (College/Career Awareness)
Attending family workshops for college/career planning (College/Career Awareness)
Preparing for college entrance exams (i.e. SAT/ACT preparation) (College Preparation)
Applying for colleges (College Readiness)
Finding money for college (i.e. FAFSA, scholarships, grants, work study, etc.) (College Financing)
Opportunities to participate in cultural activities (Cultural Enrichment)
Opportunities for leadership and community service (College/Career Preparation)
Regular check-ins and guidance on various topics listed above throughout the school year (Mentoring)

PART VI: WAIVER/RELEASE AUTHORIZATION

Voluntary Program Participation: I understand that TRiO Educational Talent Search is an optional and voluntary program being offered to the student. In consideration for the studentʻs participation in the WCC TRiO Educational Talent Search program, I agree to the following on behalf of myself, my child, and our heirs, executors, administrators, and personal representatives:

Need for Services: I agree that the student plans to go to college and would like to receive College and Career planning assistance from WCC TRiO Educational Talent Search program.

Assumption of Risk: I understand that because of the inherent dangers and risks involved with the student participating in the WCC TRiO Educational Talent Search activities and/or virtual services held during and/or after school hours, as well as after the student leaves the activities, that the student  should be covered during said period by a  private medical and liability policy; and further understand that neither the Research Corporation of the University of Hawaii or the University of Hawaii provides insurance or otherwise indemnifies individuals with respect to injuries or other liabilities arising out of participation in the WCC TRiO Educational Talent Search. I understand and acknowledge the dangers and risks involved in my child’s participation in the WCC TRiO Educational Talent Search program including the Injuries/Damages. These Injuries/Damages may be caused by the actions or inactions of my child or others participating in the WCC TRiO Educational Talent Search program, and/or the conditions where the WCC TRiO Educational Talent Search program occurs. I acknowledge that there may be other Injuries/Damages not known to me or not readily foreseeable at this time. Therefore, in consideration of the student being permitted to participate in the WCC TRiO Educational Talent Search program, I hereby fully accept and assume all risks of the Injuries/Damages resulting from my child’s participation in WCC TRiO Educational Talent Search. Further, I do for myself, my heirs, executors, and administrators hereby accept full  responsibility  for the  student’s  participation  and  agree  to  indemnify, release and discharge the Research Corporation of the University of Hawaii and the University of Hawaii, its officers, employees, agents and assigns from any and all claims or actions for property damage, personal injury, and/or death arising from the student’s participation in the WCC TRiO Educational Talent Search or growing out of or caused by any of the student’s acts or omissions during the student’s participation in the WCC TRiO Educational Talent Search program. I have read and understood all written materials setting forth the requirements for my child’s participation and I have instructed my child to observe, follow, and comply with all verbal and written instructions.

Waiver and Release: I hereby waive, release, and discharge any and all claims, demands, actions, rights, and causes of action for any and all Injuries/Damages, known or unknown, related to, arising from, or traceable either directly or indirectly to my child’s participation in the WCC TRiO Educational Talent Search program (collectively the “Released Claims”).

Indemnify, Defend, and Hold Harmless: I accept full responsibility for my child’s participation in the WCC TRiO Educational Talent Search program and I agree to indemnify, defend, and hold harmless the Research Corporation of the University of Hawaii and the University of Hawaii, and its past, present and future Board of Regents, officers, employees, agents, and assigns from any and all Released Claims and any and all demands, actions, judgments, injunctions, orders, directives, penalties, assessments, liens, liabilities, losses, damages, costs, and expenses (including attorneys’ fees), arising or resulting from or caused by any acts or omissions by my child or myself (or by any person for whom I am responsible) during, involving, or related to my child’s participation in the WCC TRiO Educational Talent Search program.

Photo, Video and Sound Recording Release and Consent: I authorize the Research Corporation of the University of Hawaii and the University of Hawaii and its officers, agents, employees, successors, licensees, and assigns to take and use photographs, video, and sound recordings of and/or live stream my child’s participation in the WCC TRiO Educational Talent Search program, and to use my child’s name, image, likeness, appearance, and voice (collectively the “Recordings”): (a) for any legitimate purpose, including any educational, institutional, scientific, fundraising or informational purposes whatsoever, (b) in perpetuity, (c) on a worldwide basis, (d) without compensation to my child or me, (e) in any manner or media, including use on social media sites and web pages accessible to the general public, and (f) alone or in combination with other Recordings. All right, title, and interest in the Recordings belong solely to the Research Corporation of the University of Hawaii and the University of Hawaii. I understand the WCC TRiO Educational Talent Search program may attract media coverage or be recorded, in whole or in part, for rebroadcast or retransmission, and I consent to my child’s inclusion in such media coverage, which may appear in print media, live or replay telecast or broadcast, podcast, and/or through social media and internet postings.

Information Release and Consent: The information reported on this form is true, correct and complete to the best of my (our) knowledge. I am also aware that the information provided must be verifiable and upon request I will provide documentation and proof of citizenship, income (i.e. tax forms, national school lunch program verification, unemployment verification, etc.), and educational status.  My signature serves as consent for the WCC TRiO Educational Talent Search to make whatever contacts necessary to obtain educational and financial information about the student, and release of such information to WCC TRiO Educational Talent Search. I understand that access to educational records is essential for WCC TRiO Educational Talent Search to serve the student’s needs, and income information is necessary in order to determine the student’s eligibility for program services. I understand that all personal information will be held in the strictest confidence.

Parent/Legal Guardian Consent, Waiver, Release, and Indemnity Agreement: I have read this Parent/Legal Guardian Consent, Waiver, Release, and Indemnity (“Agreement”) and I understand that my child and I are giving up substantial rights, including the right to sue. I acknowledge that my child is participating in the Covered Program freely and voluntarily. I agree that: (a) the laws of the State of Hawaii shall apply to this Agreement and (b) if any portion of the Agreement is deemed or held invalid, the remainder of the Agreement shall continue in full force and effect.

Student Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Legal Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.