instructions for ethnicity and race sections

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March 4, 2013
Aloha,
Honolulu Community College is pleased to announce the second Summer
Engineering Academy. Space is limited so please apply as soon as possible. Only 60
students will be selected for the Engineering Academy. The program will run from
June 17, 2013 to July 26, 2013 from 8:00 am to 12:00 noon.
Application Deadline is April 30, 2013
Registration fee is $200.00
Non-Traditional students (females) will receive a discounted registration fee of
$100.00. Please make checks payable to: University of Hawaii
Summer Engineering Academy
Summer Engineering Academy, or SEA, is an intensive summer program that offers
the student the opportunity to learn, to think, and problem-solve like an engineer.
Students will apply their knowledge of math and science to practical projects, and
see concepts they learned in high school classrooms come alive. Through lab work,
group projects, lectures and assignments, you'll learn how engineers approach realworld problems. The students will meet other students with similar interests and
collaborate on testing theories and find solutions to engineering problems.
Students will compete in the classic engineering competition of an egg drop with a twist.
As students complete SEA projects on materials, structures, chemical processes,
circuit design, computer programming, robotics, and other topics, they will gain
insights into which engineering fields best match their abilities and interests.
Fields that will be covered are Electrical, Mechanical, and Mechatronics. These
modules will be t w o weeks in length and 3 hours long each day. Students will rotate
through each module.
Students will also take an introduction to college class to prepare them for entry
into the University System. This class is designed to orient students to the college
setting. Students will be able to identify college resources, explain important
policies, demonstrate knowledge of registration procedures, discuss definition of
success and evaluate their important life roles. Students will attend this course
every morning for 1 hour.
Prerequisites are completion of geometry, completion of physics, or chemistry or
biology and basic computer skills. Fill in the application send it along with your TB and
MMR clearance, and registration fee to:
Scot Parry, Counselor
Honolulu Community College
874 Dillingham Blvd. Honolulu, HI 96817
Questions regarding the program please call or email:
Norman Takeya (808) 844-2376
ntakeya@hawaii.edu.
University of Hawai‘i
Honolulu Community College
Summer Engineering Academy Participation Form
Social Security No:
Legal Name:
Mailing Address:
Home Phone:(



City
)
State
Cell Phone:(
Female Birth Date

Male
_ _/_ _/_ _

Other

Print Last Name, First Name, Full Middle Name
Zip Code
)
US Citizen
Email Address:
Birth Place: _____________________________________
specify state or foreign country
Permanent Resident (attach copy of Resident Card)
specify country
I have Hawaiian Ethnicity (check one)
Race (circle one or more)
High School:
Ancestors:
 Not Hispanic or Latino AA AI CA CH FI GC HW IN JP
 Yes
 Hispanic or Latino
KO LA MC OA OP SA TH TO VI Month/Year
 No
Graduating
INSTRUCTIONS FOR ETHNICITY AND RACE SECTIONS
The gender, ethnic background and race of each applicant is collected for data-gathering and state and
federal report purposes.
It may also assist in the awarding of diversity scholarships. This information does not affect the
determination of admission.
ETHNICITY: Check the appropriate box on the application. Hispanic or Latino: A person of Cuban,
Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
RACE: Select one or more of the following and circle the code(s) in the appropriate box on the application.
Native Hawaiian or Pacific Islander:
Asian:
HW
Native Hawaiian/Part-Hawaiian/ Mixed
Hawaiian
SA
Samoan
TO
Tongan
GC
MC
OP
CA
Caucasian or White
IN
Asian Indian
AA
AI
Native
African American or Black
American Indian/Alaskan
CH
FI
Chinese
Filipino
JP
KO
LA
TH
VI
OA
Japanese
Korean
Laotian
Thai
Vietnamese
Other Asian
Guamanian or Chamorro
Micronesian
Other Pacific Islander
P A R T IC IP A N T & P A R E N T/ L E GAL G U A R D IA N AG R E E M E N T
The University of Hawai'i Community Colleges disclose education records without a student's prior written consent under the FERPA exception for disclosure to school
officials with legitimate educational interests. A school official is a person employed by the University in an administrative, supervisory, academic or research, or support
staff position (including law enforcement unit personnel and health staff); a person or company with whom the University has contracted as its agent to provide a
service instead of using University employees or officials (such as an attorney, auditor, or collection agent); a person serving on the
Board of Trustees' or a student serving on an official committee such as a disciplinary or grievance committee, or assist another school official in performing his or her
tasks. A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility for
the University.
I certify that the responses provided on the Summer Academy Participation Form are complete and true to the best of my knowledge and belief. I understand that
providing incomplete, incorrect, or false information may result in the denial of my participation. I understand that the UH System shares a common database and
information pertaining to me may be accessed by all UH campuses. This form is not an admission form to the UH System. Participants wishing to attend courses on a
UH System campus must meet all admission requirements for the University of Hawaii System.
I also understand and agree to the following Academy criteria:
- I grant permission to photograph my son or daughter named above for promotional and educational purposes.
__________________________________________________________________
APPLICANT SIGNATURE
_______________________________________________________________________
PARENT/LEGAL GUARDIAN NAME (PRINT)
________________________________________________________
PARENT/LEGAL GUARDIAN SIGNATURE
______________________________________
RELATIONSHIP
______________
DATE
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