PIPES Application Form

Please see the Application Instructions for all required documentation. Incomplete applications will not be considered.

All sections and fields are required unless marked “(optional).”

Program Interest:

Check all that apply.



Personal and Contact Information:





Important note: This program relies heavily on email correspondence.

MM/DD/YYYY

I identify as:

Citizenship and Residency:

Citizenship:

( )

Hawaiʻi Residency: , for

Born in Hawaiʻi:

Ethnicity and Race (optional):

This information is optional. Check all that apply.

( )


Please indicate all ethnicities you identify with:













Does your Filipino heritage include Hispanic ancestry?


Please indicate nationality you identify with:





Please indicate all nationalities you identify with:















Academic Information:

Describe your current academic institution.

Institution Size:



MM/DD/YYYY

Current Class Standing (as of Spring ):




Institution type:



Program Dates:

Do you have any summer plans that would interfere with an 10-week internship starting the Tuesday after Memorial Day (May 30, 2017 through August 4, 2017)?

Research Interest:

Research areas of interest (check top 5):














Parental Education:

Please select the highest level of education completed.

Parent One:




Parent Two:




Medical Information:

Do you have any health conditions that may interfere with performing an internship requiring outdoor/physical activities (e.g., allergies or physical limitations)?

Do you have medical/health insurance?

Verification of Honesty and Truth:

By typing my last name here, I certify that all of the statements and information provided in my application materials are true to the best of my knowledge.

Permission to Contact Instructors and Advisors:

By typing my last name here, I give the PIPES Office permission to contact my current or past instructors, advisors, and employers in regards to my performance in past/on-going related coursework/employment and my current academic standing within my institution.

Additional Documents

Don’t forget to submit the additional documents as requested on the application instructions page.