UB Interest Card

Upward Bound Program at University of Hawaii at Hilo Interest Card

Student FIRST Name *

Student LAST Name *

Student Email Address *

Student Alternative Email Address

Student Phone Number

Parent Email Address

Parent Phone Number

Alternative Phone Number

School *

Other

Grade Level *

Career interests *

Program interest *

Is the student a foster child, a ward of the State, or in the custody of a public child welfare agency? *

Yes

No

Based on the Current-Year Low-Income Levels provided below, will the student potentially qualify as low-income? (Compare taxable income only) *

Yes

No

Unsure

Federal TRIO Programs
Current-Year Low-Income Levels

(Effective January 19, 2023 until further notice)

Size of Family Unit	Taxable Income
1	$25,155
2	$34,020
3	$42,885
4	$51,750
5	$60,615
6	$69,480
7	$78,345
8	$87,210

For family units with more than eight members, add the following amount for each additional family member: $7,710 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $9,645 for Alaska; and $8,865 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.

The figures shown under family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The poverty guidelines were published by the U.S. Department of Health and Human Services in the Federal Register on January 19, 2023 and are effective as of January 19, 2023.

Does any of the student's parents/guardians have a bachelor's degree? *

Yes

No

How did you hear about Upward Bound? *

First & Last Name of the UPWARD BOUND STUDENT: *

Get in touch with us! Website:https://hilo.hawaii.edu/upwardbound/, Address: 200 W Kawili Street Hilo, HI 96720, Email: ubhilo@hawaii.edu, Phone: 808-932-7517, Fax: 808-932-7515