State of Hawai`i Department of Education / University of Hawai`i System
Spring 2015 Semester Running Start Application Form
Date:  November 28, 2015  
High School:  
Student's Name:                 
  Last  First  Middle     
Mailing Address:      City:      Zip Code:    
Home Phone:      Cell Phone:      Email:    
Class:    Jr.    Sr.          Expected Year of Graduation:  
Student is a (check one):    U.S. Citizen    Resident Alien          Foreign Student
    (copy of card required)  (additional forms required, see your high school counselor)   

If you will be applying for a GEAR UP Hawai`i Running Start Scholarship, please note that you will need to be a U.S. citizen or resident alien (i.e. permanent resident) for GEAR UP Hawai`i and/or Hawai`i P-20 to pay for your participation in this class (based on the limitations of GEAR UP's federal funding). Please ask your high school counselor if you aren't sure if this situation applies to you.
Qualifies as:    None    Economically Disadvantaged *  

* If you are economically disadvantaged (defined as receiving free lunch, reduced lunch, or the equivalent for schools not participating in the National School Lunch Program, or as participating in the Supplemental Nutrition Assistance Program – SNAP – or the Temporary Assistance for Needy Families – TANF – program), please obtain your High School's signature after you submit and print your application form. You must be economically disadvantaged AND be a U.S. citizen or resident alien (i.e. permanent resident) to apply for a GEAR UP Scholarship for Running Start.
Term and Year:  Spring 2015 Semester
University of Hawai`i Campus
Offering Course
College Course
(e.g: ENG 100)
# of
Class Location (e.g.
High School Campus or
College Campus)
High School
Requirement or
 Req.    Elect.
 Req.    Elect.
 Req.    Elect.
 Req.    Elect.
 Req.    Elect.
  1. The University of Hawai`i and the high school reserves the right to determine admission to the university/college and/or registration in certain classes.
  2. The high school is the final authority on high school graduation requirements. Students must work closely with a high school counselor to ensure that graduation requirements are met. It is understood that it is the student's responsibility to ensure that the college course(s) completed as part of the Running Start program will also meet high school graduation requirements.
  3. The parent/guardian and student understand that if the student does not successfully complete the Running Start courses, the student may not meet high school graduation requirements.
  4. The student and/or parent/guardian is responsible for tuition and campus fees, books and consumable supplies, laboratory fees, transportation, and any other related educational expenses.
  5. The parent/guardian and the student understand that the student is expected to participate fully in all course activities, including labs, which may involve being exposed to alternative viewpoints that may include material of an adult nature.
  6. The parent/guardian and student understand that the Hawai`i State Department of Education is not liable for the student's health and safety when the student has left the high school campus.
  7. The parent/guardian and student understand that students in the Running Start program have the same rights and responsibilities as any other University of Hawai`i college student.
  8. Where applicable, the student gives permission for the University of Hawai`i campus to release registration information, grades, placement test scores, student academic progress, attendance, and on track completion of coursework to his/her high school administrator(s) and/or counselors.
  9. As the parent/guardian, I give permission to the Hawai`i State Department of Education to verify the socioeconomic status of my child to the University of Hawai`i for the purpose of determining scholarship eligibility.
My signature on this form constitutes acceptance and approval of the statements listed above.
________________________________________  _______________
Student SignatureDate
________________________________________  _______________
Parent/Guardian SignatureDate
This student is enrolled at a Hawai`i public school, is under the age of 21 as of September 1st of the school year that the college course(s) will be taken, and will comply with the DOE and college's requirements.
________________________________________  _______________
High School Counselor SignatureDate
________________________________________  _______________
Principal SignatureDate
________________________________________  _______________
High School Counselor Printed NamePhone #

Click here to return to the Dual Credit Application Homepage