Course Registration Form

`Imi Pono Entry Form

Fill out the form carefully for registration
Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Race*

Native Hawaiian & other Pacific IslanderAsianAmerican Indian/ Alaskan NativeAfrican American or BlackWhiteMulti-race (2 or more)UnknownOther
Ethnicity*

Hispanic, Latino or Spanish originNOT Hispanic, Latino or Spanish originUnknown
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
School*
Grade/Year*
Signature of Parent/Guardian*
Should be Empty:

`Imi Pono Entry Form