Hawaii Leadership Residency Scholarship

1

As the program has limited resources, we cannot give to everyone who has need and have to decide based on the highest level of impact. Please describe your need honestly so that we can best assess the situation.

2

Name

First Name

Last Name

3

Email

example@example.com

4

Phone Number

Please enter a valid phone number.

5

Birthdate

Date

6

How would you best describe YOUR employment situation?

Education

Education and Employed

Employed

Unemployed

7

YOUR estimated annual income

8

Parent 1 Name

First Name

Last Name

9

Parent 2 Name

First Name

Last Name

10

How would you best describe your PARENT(s) employment situation?

Two Employed

One Employed

Unemployed

11

PARENT(s) estimated annual income

12

Please upload supportive documents

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

14

What is the total contribution from these other sources?

15

Signature

Clear