HINET Student Application

* Indicates required fields

Personal Information

*Legal First Name

Nickname or Preferred Name (if different from your legal name)

*Legal Last Name

* Date of Birth

Contact Information

UH Username
@hawaii.edu

*Alternate Email Address (only required if above field is blank)

* Cell or Other Primary Phone Number ( ) — Yes, you may send text messages

Residential Address

*Street Address

*City

*State abbreviation

*Zip Code

*Which island do you live on?

Education Information

*Currently enrolled in

UH Home Campus or UH Campus Applied To

If non-credit, which program are you enrolled or interested in?

Career interests

How was/is your tuition being paid? (check all that apply)

Eligibility

* Are you currently receiving TANF (Temporary Assistance for Needy Families)?

Are you receiving SSDI (Social Security Disability Insurance)?

* Are you a U.S. Citizen/U.S. National, or permanent resident for 5+ years (green card)?

Are you Native Hawaiian?

* Are you currently receiving SNAP benefits?

If not receiving SNAP, would you like assistance with applying?

How many people are in your household including yourself?

* Who do you live with? (check all that apply)

* Do you receive regular monthly financial support? (check all that apply)

Employment Information

Current Employment Status

* Are you currently employed?

How many hours do you work in a week, on average?

What is your hourly wage?

Are you receiving unemployment benefits? *

How much unemployment do you receive each week?

Self-Employment Status

* Are you self-employed?

How many hours do you work in a week, on average?

How much do you earn per month from self employment?

Other

If you have any extenuating circumstances or would like to share any issues for us to assist with, please list them below. (examples: childcare access issues, looking for employment, homelessness, foster care system, etc.) (maximum 1,000 characters)

How did you hear about the HINET program?

By submitting this application, I certify that if I am selected and while I am in the program, I understand and agree to the following:

I will immediately contact a HINET staff member if my program of study or enrollment changes.
I am responsible for meeting with a HINET staff member at least monthly to verify monthly career activity.
I will follow the Student Code of Conduct outlined in Executive Policy 7.208 and maintain honesty and integrity throughout the HINET program.