Thank you for your interest in our TRIO Mānoa - Student Support Services program!

Due to the nature of the TRIO Mānoa - SSS program being funded through a grant from the United States Department of Education, we will need you to provide some personal and financial information to determine your eligibility. All of the information you provide will be kept confidential and only be viewed by the TRIO Mānoa Staff.

So that we may determine your eligibility and begin to provide you with services, please take a few minutes to complete the application in its entirety. Be sure to include all signature where required and all supporting documentations, as noted.

*Note: You cannot save and restart this application, therefore you may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. If you have any questions, email us at trioadv@hawaii.edu or contact our office at (808) 956-8402.

General Information:

Student ID Number *

UH Username *

Last Name *

First Name: *

Middle Name

Date of Birth *

Gender *

Pronouns *

Address *

City *

State *

Zip Code *

Cell Phone Number *

Cell Phone Opt Out

UH Email Address *

Referred by

Academic Information:

Semester and Year Entering/Entered UH Mānoa (i.e. Fall 2024) *

Is UH Mānoa Your Home Campus? *

Eligibility Information:

Citizenship:

Are you a Citizen, National, Permanent Resident of the United States? *

Meet Residency Requirements to Apply for Free Application for Free Student Aid (FAFSA): Includes American Samoa, Guam, the Marshall Islands, Micronesia, Palau, and Northern Marianas Island students

First-Generation College Student:

Has your MOTHER received/earned a 4-year college degree? *

Has your FATHER received/earned a 4-year college degree? *

Have you ever been in foster care or in a court appointed guardianship? *

Income Eligibility Criteria:

Dependency Status:

Independent Student: An independent student is one of the following: at least 24 years old, married, graduate or professional student, a veteran, a member of the armed forces, an orphan, a ward of the court, someone with legal dependents other than a spouse, an emancipated minor or someone who is homeless or at risk of becoming homeless.

Dependent Student: A dependent student is under 24 years old and does not fit under any of the categories listed under independent student above.

Based on the above definitions, I certify that I am: *

Please use the following household number and "Taxable Income" guidelines for Federal TRIO programs:

For family units with more than eight members, add the following amount for each additional family member: $8,070 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $10,095 for Alaska; and $9,285 for Hawaii.

The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.

If you or your parent(s) filed 2022 U.S. federal income taxes, "Taxable Income" can be found on line 15 of the 1040 form.

Please note that taxable income is usually less than the adjusted gross income.

Example 1: If there are 6 people in your household and file taxes in Hawaii, see if your household’s “Taxable Income” is at or below $72,390.
Example 2: If there are 9 people in your household, you would check to see if your household’s “Taxable Income” is at or below $101,055.

Based on the above income levels, I certify that *

Financial Aid Information:

Did you Apply for FAFSA (Financial Aid) for 2024-2025 Academic Year? *

Are you receiving Federal Pell Grant for 2024-2025 Academic Year? *

Race/Ethnicity (answer all & select all that apply):

Race, Hispanic *

Race, American Indian or Alaskan Native *

Race, Asian *

Race, Black or African American *

Race, Hawaiian or other Native to Pacific Island *

Race, White *

Academic Need:

Please select any experiences you have encountered from the list below. (check all that apply)

Low High School Grades

Low Admission Test Scores

Academic Proficiency

Low College Grades

High School Equivalency or GED

Failing Grades (Academic Actions)

Out of College 5+ Years

Limited English Proficiency

Lack of Academic or Career Goals

Lack of Preparedness for College Level Work

Need Academic Support to Raise Grades

Long Commute (1 hour+)

Student Parent

Familial Responsibilities

Welfare Recipient

Working 20+ hours

Personal Problems

No Support System

Unfamiliar with Campus/ Campus Resources

Transfer Student

Which TRIO Mānoa services/support are you interested in? (check all that apply)

Academic and Career Exploration Course (UNIV 132)

Academic/Career/Financial Advising

FAFSA Assistance & Information/Financial Literacy

Tutoring & Coaching

Office Use (Study Space/Computer Use/Printing)

Graduate School/Professional School Advising

Life/Study Skills Assistance

Cultural/Educational/Community Events

Basic Need Insecurity

Mental Health/Wellness Resources

Campus/Community Resources

Documented Disability:

Do you Have a Documented Disability? (No Documentation will be Collected) *

The Kokua Program is the UH Mānoa office for students with disabilities. They serve undergraduate, graduate and professional students with learning, physical, psychiatric and other documented disabilities. Kokua collaborates with students, faculty, staff to facilitate equal access for students with disabilities to the Mānoa experience.

Hours: Monday – Friday 8:00 AM to 4:00 PM
Office Address:
Queen Lili`uokalani Center for Student Services
2600 Campus Road, Room 013
Honolulu, Hawaii 96822
Main Office Phone: (808) 956-7511 (Voice or TTY)
Email: kokua@hawaii.edu

Photo Release:

By signing below, I authorize the University of Hawai‘i and its officers, agents, employees, successors, licensees, and assigns to take and use photographs, video, and sound recordings of and/or live stream my participation in the Covered Program, and to use my name, image, likeness, appearance, and voice (collectively the “Recordings”): (a) for any legitimate purpose, including any educational, institutional, scientific, fundraising or informational purposes, (b) in perpetuity, (c) on a worldwide basis, (d) without compensation to me, (e) in any manner or media, including use on social media sites and web pages accessible to the general public, and (f) alone or in combination with other Recordings. All right, title, and interest in the Recordings belong solely to the University of Hawai‘i. I understand the Covered Program may attract media coverage or be recorded, in whole or in part, for rebroadcast or retransmission, and I consent to my inclusion in such media coverage, which may appear in print media, live or replay telecast or broadcast, podcast, and/or through social media and internet postings.

Authorize Photo Release *

Applicant Signature *

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.

Authorization & Verification

1. I understand that the TRIO Mānoa - SSS program is funded through a federal grant from the U.S. Department of Education and required to verify my eligibility utilizing the information included in this application.

2. I hereby authorize TRIO Mānoa - SSS staff to obtain academic, financial, and other information pertinent to my participation in the TRIO Mānoa - Student Support Services program.

3. I understand that my application and its contents will be stored electronically on a secure database maintained by the TRIO Mānoa - SSS program staff and will be kept confidential in compliance with the Family Educational Rights and Privacy Act (FERPA).

4. I understand that completion of this form does NOT guarantee acceptance into the TRIO Mānoa - SSS program.

5. I will respect the rights of others, including belongings, personal space, the right to personal opinion, and privacy.

6. I will refrain from inappropriate behaviors, profanity, outbursts, or any other threatening behaviors toward myself or others.

7. I understand that once I am accepted into the TRIO Mānoa - SSS program, I must participate in TRIO Mānoa - SSS programming at least once per semester.

8. I certify that the information contained herein is true and complete to the best of my knowledge.

Sign and Submit:

Terms of Submission: By submitting this application, I acknowledge that all of the above information inputted in this application is correct and accurate to the best of my understanding.

Applicant Signature *

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.