University of Hawai’i at Hilo Scholars with Disabilities Achievement Grant The Scholars with Disabilities Achievement Grant recognizes a student with a documented disability who has demonstrated superior scholastic performance and who plans to enroll at the University of Hawai’i at Hilo for the Spring 2011 academic semester. Eligibility Students meeting all of the following qualifications may apply. 1. Currently enrolled classified student, or accepted as a classified student into a University of Hawaii at Hilo degree program. Student may be enrolled either full- or half-time. 2. Academic merit as demonstrated by a grade point average of at least 3.0 in high school, college, or university setting. 3. Student is determined to be a “qualified student with a disability” as determined under the Americans with Disabilities Act standards-guidelines provided. (An IEP and or 504 plan is not sufficient.) Applications Requirements 1. Submit a completed and signed Scholars with Disabilities Application Form to the University Disability Services Office, UHH, Hale Kauanoe A Wing, 200 W. Kawili St., Hilo, Hawaii 96720, by December 17, 2010. 2. A Personal Statement – guidelines provided 3. Letter of Recommendation – form provided 4. Documentation substantiating disability as determined by the Americans with Disabilities Act standards. Documentation submitted will be considered highly confidential, and will not be returned to applicant. Condition of Award One award will be made every academic semester, and all applicants will need to competitively apply each semester for the Achievement Grant. Achievement Grant will apply to one academic semester only, and will be applied towards the tuition fee in the amount of $1000.00. Students may be asked to show progress throughout the semester. Award letter to be mailed out by June 30, 2010. Applications and all supporting documents should be submitted to Scholars with Disabilities Achievement Grant, c/o Disability Services, University of Hawai’i at Hilo, 200 W. Kawili Street, Hilo, HI 96720. Applications must be postmarked no later than December 17, 2010. University of Hawaii at Hilo Scholars with Disabilities Achievement Grant Application Application Deadline: December 17, 2010 Please type or print: Name:_________________________________________________________________ Last First Middle Social Security:_____/____/_____ Sex: Male_____ Female____ Mailing Address:_______________________________________________________________ Number Street City Zip Code Home Phone:_________________________ Work Phone:__________________ Permanent Address:_____________________________________________________ Number Street City Zip Code Date of Birth:____/____/____ Marital Status: Single_____ Married_____ Divorced_____ Widowed____ Education High School Attended:________________________________Year Graduated______ University/College Level: Fresh_____ Soph_____Junior_____ Senior_____ Grad_____ Certificate_____ Major:______________________ Current GPA:________ Cumulative GPA:________ List all colleges attended other than UHH Institution From/To Degree Major I attest that all the information on this application is true and correct to the best of my knowledge. I agree to provide supporting documents and further verification upon request and authorize the Scholars with Disabilities Achievement Grant Committee access to my educational records. Signature___________________________________________ Date_________________________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PERSONAL STATEMENT Describe your reasons for pursuing a college education, your selection of the discipline of study, and how they relate to your life and career goals. Please include any previous or current activities that demonstrate your leadership potential, and special skills or talents that will be of benefit to your community. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Recommendation Form To the applicant: Print your name, social security number and sign to waive/not waive access to this letter of recommendation. Refer this form to a faculty member, instructor, or teacher who can evaluate your academic strengths and weaknesses. Applicant’s Name _______________________________________________________________ Student ID No.__________________________________________ Please check and sign in accordance with the Family Educational Rights and Privacy Act of 1994. I hereby ______waive ______do not waive my right of access to this letter of recommendation ____________________________________________ ______________________________ Signature of Applicant Date To the Recommendation source: Use an additional page if necessary. The recommendation is an important part of the student application. Please respond candidly to the items below, sign and return your recommendation either to the applicant, or the address listed below. The questions may be addressed on an attached statement. 1. How well and in what capacity do you know the applicant? 2. Is there evidence of the student’s academic accomplishments or potential that is not directly reflected in the GPA? 3. What are the applicant’s previous and current activities that demonstrate leadership potential? 4. In what way do you expect the applicant to provide leadership or service to the community? What are the special skills or talents of the applicant that will benefit the community? Deadline: December 17, 2010 Date _______________ Signature___________________________________ Print Name and Title_________________________________________________ Print Address_______________________________________________________ This form can either accompany the application or be returned to: Scholars with Disabilities Achievement Grant, c/o Disability Services, University of Hawai’i at Hilo, 200 W. Kawili Street, Hilo, HI 96720.