ALU LIKE, Inc. Hana Lima Scholarship Application

ALU LIKE, Inc.
Hana Lima Scholarship Application - Spring 2013
POSTMARK DEADLINE: January 31, 2013
The purpose of this Hana Lima Scholarship is to give .nancial assistance to students participating in a vocational
or technical education program for occupations that can provide a “living wage.” This COMPETIVE Scholarship is available
to students in vocational programs that lead to a specific segment of employment. Eligible programs include, but are not
limited to, diesel mechanics, automotive technology, nursing, medical assisting, cosmetology and emergency medical
technician. Students pursuing a major in Liberal Arts do not qualify for this award as this scholarship supports students
who have declared and are committed to a specific program of study. Preference is given to non-traditional students:
single parents, disabled (meets ADA definition), houseless, sole income providers, previously incarcerated and wards
of the court.
As an applicant, you must meet the following criteria:
l
Be of Native Hawaiian ancestry.
l
Be a resident of the state of Hawai‘i.
Be enrolled in a vocational degree or certification program (AS or AAS--Associate’s Degree) for the
term in one of the educational institutions listed below (additional institutions available at www.alulike.org):
l
Hawai‘i Community College
Heald College (AA)
Kapi‘olani Community College
Leeward Community College
Med Assist School of Hawai‘i
Hawai‘i Technology Institute
Honolulu Community College
Kaua‘i Community College
Maui Community College
Windward Community College
* On-line courses will be considered on a case by case basis. If you have any questions about whether other comparable
institutions qualify, please call us at 808-535-1313.
Terms and Conditions:
The Hana Lima Scholarship is a $1,500 award to be used toward tuition and fees, books and other required tools or
uniforms for a vocational program. Scholarship checks are mailed directly to the financial aid office and are disbursed
only upon proper verification of Native Hawaiian ancestry, at least half-time enrollment status (at least 6 credits for Spring
2013) and current academic standing (at least 2.0 grade point average).
If you have any questions about the Hana Lima Scholarship, please contact
ALU LIKE, Inc. Ka Ipu Ka‘eo Department at
[email protected] or at (808) 535-6745
Send this completed application and required documents to:
ALU LIKE, Inc.
Hana Lima Scholarship
c/o Keone Kamauoha
458 Keawe Street, Honolulu, HI 96813
Page 1 of 5
ALU LIKE, Inc.
Hana Lima Scholarship Application - Spring 2013
POSTMARK DEADLINE: January 31, 2013
Incomplete and late applications will not be considered.
Have you received the Hana Lima Scholarship in the past?
Yes
No
If yes, when were you awarded (semester & year)?
PART 1: Applicant-INCLUDE COPY OF BIRTH CERTIFICATE INDICATING HAWAIIAN ANCESTRY
Name:
Last
First
Social Security (last four digits only): Gender:
Female Middle
Date of Birth: _
Male Island:
Mailing Address:
Street or PO Box Permanent Address:
Street
Telephone: City
State
Alternate Telephone: Zipcode
Email:
Are you the first in your family to attend a post-high school program?
Are you of Hawaiian or part-Hawaiian ancestry?
Yes
Do you have a high school diploma, or its equivalent?
Yes
No
No
Yes
High School:
No
Year:
PART 2: Program Information-INCLUDE COPY OF ACCEPTANCE LETTER AND CLASS SCHEDULE
Name of program/major (no acronyms):
School you plan to attend:
When did/will you start this program?
When do you expect to graduate from this program?
What degree or certification will you receive upon completion of your program?
Current GPA (Most recent semester’s GPA). Cumulative GPA (Total average GPA)
(Does not apply to incoming Freshmen)
Page 2 of 5
PART 3: Non-Traditional Status
Please check all that apply to the applicant:
Single parent Sole income provider for others
Disable (meets ADA definition) Previously incarcerated
Houseless Ward of the court
N/A
PART 4: Financial Information:
Applicant Status
Single
Married Family Size: Divorced
Separated
Widowed
Domestic Partnership
Number of Dependents:
Please select the appropriate box to indicate your combined annual household family income for the
previous year.
$0 - $5,000 $5,000 to $15,000 $15,001 to $25,000
$25,001 to $35,000 $35,001 to $45,000 $45,001 to $55,000
$55,001 to $65,000 $65,001 to $75,000 $75,001 to $85,000
$85,001 to $100,000 Over $100,000
Public assistance: (Check all that apply and include monthly amount)
TANF: Food Stamps: GA/SSI: WIC:
Employment Status: Full-time Employer: Part-time Other:
Self-Employed Unemployed Title: Laid Off
Hourly Wage:
PART 5: Student Breakdown of Cost-include account balance and transcript for most recent school
Please attach with this application, your printout of the classes for which you registered for Spring 2013 (Class Schedule
or Registration). Also include the printout of the “Account Balance” of payments made or amounts owed for Spring 2013.
PROGRAM EXPENSES:
Please indicate the estimated costs of your program of study for the 2012-2013 academic year.
Tuition (for Spring 2013): $
Books (estimated cost for Spring 2013): $
Uniforms/Tools (describe: )$
Program Fees (describe: )$
Childcare (describe: )$
Transportation (describe: )$
Other (describe: )$
TOTAL: $
Page 3 of 5
FINANCIAL ASSISTANCE -Please list financial assistance that you have applied for or were awarded.
INCLUDE STATEMENT FROM SCHOOL EVEN IF FINANCIAL AID IS NOT OFFERED OR AVAILABLE
#1 $
#2 $
#3 $
#4 $
#5 $
TOTAL: $
PART 6: Pre-Guidance Counseling-INCLUDE RESPONSES ON A SEPARATE PAPER
Please answer the following questions:
1. What is your program of study? How did you choose this program? What are some experiences (work
experience, family and/or personal situation, etc.) that made you interested in getting into this program?
2. At the end of your training or education, what type of job will you be seeking? Name a few of your
strengths and experiences that make you well-suited for such employment?
3. What are your short-term and long-term goals? Are there any challenges you foresee? How will you
overcome these challenges and reach your goals?
Checklist of Required Documentation for All Applications:
Failure to submit all required documentswill cause your application to be considered incomplete.
Acceptance letter For UH system students:
1). Log on to your myUH portal
2). Under`Registration’ click on “Check Registration Status”
3). Select “Spring 2013” then print and submit
Birth Certificate verifying Native Hawaiian ancestry (photocopy)
Transcript for college academic work completed to date.
Photocopies acceptable For UH system students: MyUH portal “Transcript” printout acceptable
Official printout of Spring 2013 Class Schedule
Account Balance for 2012-2013 academic year (total cost of program)
For UH system students:
1). Log on to your myUH portal
2). Under `Student Records’ click on “View Charges/Make Payment”
3). Select “View My Account (charges and payments) for Each Term” then print and submit
For Heald College students: Your “Estimated Financial Aid Award” letter
Financial Aid Award Letter/Package:
(This needs to be submitted regardless of financial aid award or acceptance)
For UH system students:
1). Log on to your myUH portal
2). Click on “Financial Aid”
3). On “Award by Aid Year” under “My Award Information”
4). Select “Aid Year 2012-2013” from the “Select Aid Year” then print and submit
For Heald College students: Your “Estimated Financial Aid Award” letter
Answer Pre-Guidance Counseling Questions-Part 6
Page 4 of 5
How did you hear about ALU LIKE, Inc.?
Self
Friend or Family
Informative Publication
Hawaiian Agency
Healthcare Provider
Other Agency
Other ALU LIKE Participant
Other Source
What other ALU LIKE, Inc. services have you requested in the past?
Childcare Assistance
Employment & Training
Early Childhood Education
Fishery Observer Training
Kupuna Services
Individual Development Accounts
Information & Referral
Library services
Literacy Services
Offender/Ex-Offender Services
Youth Services
Other Services
Certification:
The above information is true and correct. If asked by ALU LIKE, Inc., I agree to provide further documentation
for information given on this form. I understand the application process will be terminated or my application will be
disqualified by ALU LIKE, Inc. if any information that I have given in this application or to any third party as part of
the qualifying process is false or misleading or if I have failed to provide timely information requested regardless of
time elapsed after discovery. I shall be subject to termination of funds and repayment of funds, including reasonable
attorney’s fees incurred to collect such refund. I understand that this application and all required documents, including
documents provided to a third party as part of the application process, shall become the property of ALU LIKE, Inc.
and that forms and/or documents will not be returned. I understand that financial aid and scholarships are subject to
availability of funds.
Applicant Signature Date
NOTE: If selected as an award recipient you MUST ATTEND an orientation with a Kamehameha Schools Ka'i Lamaku
Post-High Counselor, prior to receiving an award.
Page 5 of 5