Hawai'i Language Roadmap VCHAT Program
Interest Form
Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How did you hear about the program?
*
Participant Status
*
Kupuna
High School Student and/or Recent Graduate
University / Community College Student and/or Recent Graduate
Are you a State Seal of Biliteracy or Global Seal of Biliteracy Awardee?
*
Yes
No
Please identify the type of Seal you were awarded and for what language(s)
*
(E.g., State Seal - Japanese)
Would you like to learn more about the State Seal of Biliteracy or Global Seal of Biliteracy?
*
Yes, I'm interested in learning more
No, I'm a current applicant
No, not at this time
Name of High School / Alma Mater
*
Name of High School Alma Mater
*
Name of Current College / University
*
Grade level
*
9th grade
10th grade
11th grade
12th grade
Recent graduate
How do you prefer to be contacted?
*
Email
Call
How do you prefer to be contacted?
*
Email
Call
Text
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Conversation Group Matching Information
What language are you looking to participate with?
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If you speak more than one language other than English please list the language you are most interested in using to participate.
Please rate your speaking and listening abilities on a scale of 1-7. A rating of 7 indicates native speaking and listening ability and a rating of 1 indicates you have just started learning the language. If you feel comfortable using your language with someone you are meeting for the first time and feel you could manage an extended conversation on your own, then an evaluation in the range of 5 or 6 is appropriate.
*
Describe your comfort level speaking with new acquaintances on a scale of 1-5 (1 - extremely uncomfortable : 5- extremely comfortable).
*
If we are unable to pair you with a partner in the language you identified above, is there another language that you can communicate in and are interested in using for the program.
Please write N/A if there is no other language you can communicate in and are interested in using for the program.
Please rate your speaking and listening abilities on a scale of 1-7 for the additional language you would be willing to communicate in for the program.
Describe your comfort level speaking with new acquaintances on a scale of 1-5 for the additional language.
To help us pair you in your conversation group please tell us in a few words why you are interested in this program and what you want to get out of it?
*
Please provide an answer that will help us match your interests with other students and with a kupuna.
I am generally available to participate in a video chat session (check all that apply). This information will be shared with your conversation groupmates.
*
weekday afternoons
weekday evenings
Saturday mornings
Saturday afternoons
Sunday mornings
Sunday afternoons
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Acknowledgement & Consent
I understand that participating in the VCHAT program is a completely voluntary activity.
Yes
I agree to communicate using the target language to the best of my abilities when meeting with my conversation group.
*
Yes
I agree to act in a respectful and professional manner when interacting with Hawai’i Language Roadmap personnel and fellow participants.
*
Yes
I understand meetings with my language conversation group will be online. If any technology assistance is needed, I understand I can contact roadmap@hawaii.edu for support.
*
Yes
I agree not to share any participant contact information for use other than the designated program and agree not to record any of the conversation or photograph fellow participants without explicit permission.
*
Yes
I agree to meet with my language conversation group at least once a month for at least 3 months, but I understand that there is no required meeting dates and times for VCHAT and it is my group’s responsibility to make a schedule that works best for everyone. Hawai’i Language Roadmap Initiative will ensure all participants have contact information and will provide support in scheduling meetings if additional help is needed.
*
Yes
I agree to participate in the online orientation before meeting with my language conversation group.
*
Yes
Type your name below if you agree to follow program expectations stated above. If you are not yet 18 please have a parent or legal guardian review the form and sign (type) their name.
*
I am already 18 years old.
I understand that I will need a parent or legal guardian to sign a permission form for my participation in this program.
Type your name below if you agree to follow program expectations stated above. If you are not yet 18 please have a parent or legal guardian review the form and sign (type) their name.
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