Bridge To Hope
NEW PARTICIPANT INFORMATION
- Please complete the form (click & type in the grey area)
- Save it
- Email the file as an Attachment to:
- Print & give a copy to your BTH campus contact
Date:
First Name: Last Name:
Other Names used:
UH ID#:
Gender: Female Male
Year of birth: Age in years:
What is your Ethnic Background?
If Multi-ethnic, please indicate which group(s) you most strongly identify with?
A. B.
CURRENT MAILING ADDRESS:
Address:
City: State: Zip:
Home phone: Cell phone:
UH email: Alternate email:
PERMANENT CONTACT PERSON: (Please provide someone who can help BTH keep in contact with you in case your address changes. We would like to know what participants are doing after UH.)
First Name: Last Name:
Relationship to you: Phone:
Address:
City: State: Zip:
Email:
HOUSEHOLD:
Are you a: Single parent Two-parent household
No. of children at home:
Ages of children at home:
1. 2. 3. 4. 5.
EDUCATIONAL BACKGROUND:
Did either of your parents complete a BA/BS degree? Yes No
When was the first time you enrolled in college?
A. Year: B. Fall Spring Summer
Did you attend college at any time before your current enrollment and leave before
completing a degree? Yes No
If Yes, when did you return to school on a UH campus?
A. Year: B. Fall Spring Summer
Which campus are you currently attending? (Check all that apply)
UH Hilo Kapiolani Community College
UH Manoa Kauai Community College
UH West Oahu Leeward Community College
Hawaii Community College Maui Community College
Honolulu Community College Windward Community College
What is your enrollment status? Full-time Part-time
No. of credits:
What is your academic program?
Certificate in (please specify)
Associate in Arts (AA)/Associate of Science (AS)/Associate of Applied Science (AAS)
Bachelor of Arts (BA)/Bachelor of Science (BS)
Masters of Arts (MA)/Masters of Science (MS)/ or Professional Degree (i.e. JD)
What is your current major?
What is your intended major (if different):
When do you expect to graduate?
Once you have completed the form, save it with your answers and email the file as an attachment to:
If you have problem in emailing this file, you can print and send it to:
Bridge to Hope Program
2600 Campus Rd. QLC #211, Honolulu, HI 96822
Phone: 808-956-9313 Fax: 808-956-9314
If you have any questions, please feel free to call or email us at: .
Continue to pages 3 &4 for additional info for your BTH campus contact.
Bridge To Hope
FIRST TO WORK PARTICIPATION VERIFICATION
Note: To complete the form (click & type in the grey area.)
Complete and return to your BTH campus coordinator with your case manager’s verification of work hours required.
Student Name:
First to Work Case Manager Contact Information:
Name:
Unit & Location:
Phone #:
Email:
Fax:
Total number of hours of “work activity” required:
Number of months of TANF eligibility remaining:
Student is: (Please check 1)
Utilizing Voc Ed/Training (VET) as “Core Hours” OR
Utilizing “Job Skills Training” as “Non-Core”
Other (Please specify)
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Cash Assistance: Processing Center & Contact Info for “Changes” Team
(To inform FTW of BTH “exempt” earnings)
Unit Name & Location:
(e.g. Pohulani Processing Center at 677 Queen St.)
Phone #:
Fax #:
Work and College Experience
PREVIOUS EMPLOYMENT: (Most recent first)
Job title:
Skills:
From (mm/yyyy): To (mm/yyyy):
Job title:
Skills:
From (mm/yyyy): To (mm/yyyy):
Job title:
Skills:
From (mm/yyyy): To (mm/yyyy):
PREVIOUS COLLEGE ATTENDANCE: (most recent first)
College:
From (mm/yyyy): To (mm/yyyy):
College:
From (mm/yyyy): To (mm/yyyy):
College:
From (mm/yyyy): To (mm/yyyy):
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