Online Application Worksheet COP 2016 2600 Campus Road QLCSS 308 Honolulu, HI 96822 Phone (808) 956-6186 www.hawaii.edu/cop
STEP 1: Applicant Information Page 1 NAME/PERSONAL INFORMATION * Last Name (Legal name) * First Name Middle Initial * Gender * Birth Date (State or Foreign Country) * Age * Birthplace * Citizenship USA or Other If Other, enter visa type: * Ethnicity (check all that apply) African, African-American American Indian or Alaskan Native Asian: Chinese, Korean, Japanese Filipino Hawaiian Pacific Islander: Fijian, Micronesian, Samoan, Tahitian, Tongan Southeast Asian: Cambodian, Laotian, Thai, Vietnamese Hispanic: Puerto Rican, other Hispanic Other (please specify): * Is English your first language? If No, what is your first language? CONTACT INFORMATION Your Current Mailing Address * Number - Street * City * State * Zip Code * Island * Primary Phone Number Secondary Phone Number Note: If you do not know the answer to a question with an asterisk (*) when doing the online application, do not leave it blank. You will not be able to move forward unless you enter an answer. Place a question mark and update your answer later when you are ready to complete your application.
Page 2 STEP 2: Education and Scores HIGH SCHOOLS * Name of High School Graduated/ Will Graduate From * Date Attended From Month: Year: * Date Attended To Month: Year: * Graduate/Will Graduate Month: Year: Cumulative GPA * (at end of Junior Year) COLLEGES * Have you received or plan to earn any college credits prior to June 2016? If Yes, enter institution(s) If Yes, number of credits 100 level and above already earned If Yes, number of credits 100 level and above currently taking Note: If your cumulative GPA is below 2.0, you are not eligible for COP. Note: Send a copy of your college transcript to COP * Have you applied to UH Mānoa? If Yes, when did you apply? Month: Year: * Will you be applying to any other college or university? Provide a ranked-order list of schools you will be applying to 1st Choice: 2nd Choice: 3rd Choice: 4th Choice: 5th Choice: 6th Choice: STANDARDIZED TEST SCORES * Have you taken the Scholastic Assessment Test (SAT) or the American College Test (ACT)? A.) If Yes, complete this section for SAT and/or ACT B.) If No, you must have taken the SAT and/or ACT 1 2 1 2 Yes - I have taken the SAT Yes - I have taken the ACT No - (skip to Item B) SAT Scores Date Taken: Evidence Reading & Writing: Math: Total: ACT Scores Date Taken: Critical Reading: Math: Writing: Composite: Note: You are required to submit your SAT and/or ACT scores to complete your application.
STEP 3: Financial Information Page 3 GENERAL QUESTIONS * 1. Are you currently working and getting paid? If Yes, where? How many hours per week? What was your gross income? (Select One) * 2. Do you or your family receive any form of public assistance? * 3. Do you receive any benefit/support for yourself? If Yes, what type of benefit/support? How much per month? 4. Check here if you are unclear about your family's benefit, but know your family receives some type. * 5. Do you have the approval of your family to enter COP and reside at UH Mānoa? * 6. Do you personally want to live on the UHM campus in a coed residential hall during the summer and first academic year? FINANCIAL INFORMATION * 1. Please indicate your family size. Number of individuals in the family. * 2. Did your parent(s)/guardian(s) file their 2015 Federal Income Tax Return? If Yes, what was their adjusted gross income (AGI)? If No, please explain. * 3. Please indicate your family's estimated 2016 annual income? Under $1,000 $1,000-$3,499 $3,500-$7,000 Over $7,000 (i.e., AFDC, DHS, Hawai'i Housing, etc.) (i.e., social security, child support, etc.) Not sure #: This should include you and your parents/guardians and anyone in the household who receives at least half of their support from your parents/guardians. Also include siblings who may be living away from home while attending college. $ $
STEP 4: Family Information Page 4 PARENT 1 * Relationship to Applicant If Other, please explain. * Last Name * First Name * Current Address: Number - Street * City * State * Zip Code * Primary Phone Number Secondary Phone Number * Occupation/Employer * Marital Status * State of Legal Residence * Did this person complete a bachelor's degree? If Yes, which college did this person attend? (indicate state and/or country) PARENT 2 Relationship to Applicant If Other, please explain. Last Name First Name Current Address: Number - Street City State Zip Code Primary Phone Number Secondary Phone Number Email Address Occupation/Employer Marital Status State of Legal Residence Did this person complete a bachelor's degree? If Yes, which college did this person attend? (indicate state and/or country)
STEP 5: Recommendations Page 5 1. COLLEGE PREPARATORY INSTRUCTOR * Name * Course Taught * School * Phone Note: Letter of Recommendation form will be emailed to them when you submit your online application. 2. GRADE LEVEL OR COLLEGE & CAREER COUNSELOR * Name * Title * School * Phone Note: Letter of Recommendation form will be emailed to them when you submit your online application. REFERRAL (Who informed you about COP?) * Name Relationship School/Organization STEP 6: Personal Essay Questions Write your essay prior to starting the online application and cut/paste your responses to each of the five essay questions. There is a maximum 1,000 characters per question. 1. Describe your current living situation and family members. Where do you live and with whom? Identify each member in the household by name, age, and relationship to you. 2. Why do you want to attend UH Mānoa? What major(s) do you plan to pursue? How did you decide on your major(s)? 3. What are the current activities that you are involved in at school and in your community? 4. Why are you applying to COP and what are your alternative plans. 5. Share with us any other information you feel would support your application. Note: Your essay will be screened by a selection committee. They will be reading and rating your personal essay to determine your eligibility and motivation for the COP program. You will be able to copy and paste your answers from a word document to your online application.