COP 2021 Online Application Worksheet - This is only a worksheet to help you fill out the application online. This is not the official ...
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COP 2021
Online Application
Worksheet
(This is only a worksheet to help you fill out the
application online. This is not the official application.)
2600 Campus Road QLCSS 308 Honolulu, HI 96822 – Phone (808) 956-6186
www.hawaii.edu/copCOLLEGE OPPORTUNITIES PROGRAM: APPLICATION WORKSHEET
Page 1
STEP 1: Applicant Information
NAME/PERSONAL INFORMATION
* Last Name (Legal name)
* First Name
Middle Initial
* Gender
* Birth Date (State or Foreign Country)
* Age
* Birthplace
* Citizenship (If Other, enter visa type) USA or Other:
* Ethnicity (check all that apply) African, African-American
American Indian or Alaskan Native
Asian: Chinese, Korean, Japanese
Filipino
Hawaiian
Pacific Islander: Fijian, Micronesian, Samoan,
Tahitian, Tongan
Southeast Asian: Cambodian, Laotian, Thai,
Vietnamese
Hispanic: Puerto Rican, other Hispanic
Other (please specify):
* Is English your first language? Yes No
If no, what is your first language?
When did you first start school in the US?
(Month/Year/Grade)
CONTACT INFORMATION
Your Current Mailing Address
* Number - Street
* City
* State
* Zip Code
* Island
* Applicant Primary Phone
(COP may send texts to this number)
Optional Phone Number
(In case COP is unable to reach you at your primary)
* Email Address
*All communication regarding your application status will be done through this contact email.
Note: If you do not know the answer to a question with an asterisk (*) when doing the online application, do not leave it
blank. You will not be able to move forward unless you enter an answer. Place a question mark and update your
answer later when you are ready to complete your application.COLLEGE OPPORTUNITIES PROGRAM: APPLICATION WORKSHEET
Page 2
STEP 2: Education and Scores
HIGH SCHOOLS
* Name of High School Graduated/Will Graduate From
* Date Attended From Month: Year:
* Date Attended To Month: Year:
* Graduate/Will Graduate Month: Year:
Cumulative GPA
* (at end of Junior Year)
Note: If your cumulative GPA is below 2.0, you are not eligible for COP.
COLLEGES
* Have you received or plan to earn any college credits
Yes No
prior to June 2021?
If Yes, enter institution(s)
If Yes, number of credits 100 level and above already
earned
If Yes, number of credits 100 level and above
currently taking
Note: Include a copy of your college transcript with your other documents that you will be submitting to COP.
* Have you applied to UH Mānoa? Yes No
If Yes, when did you apply? Month: Year:
* Will you be applying to any other college or
Yes No
university?
Provide a ranked-order list of schools you will be 1st Choice:
applying to 2nd Choice:
3rd Choice:
4th Choice:
5th Choice:
6th Choice:
STANDARDIZED TEST SCORES
* Have you taken the Scholastic Assessment Test ☐ Yes - I have taken the SAT
(SAT) or the American College Test (ACT)? ☐ Yes - I have taken the ACT
(Test scores are optional for COP 2021) ☐ No
SAT Scores
*If Yes, complete this section for SAT and/or ACT
Date(s) Taken:
1 Evidence Reading & Writing: Math: Total:
2 Evidence Reading & Writing: Math: Total:
ACT Scores
Date(s) Taken:
1 Critical Reading: Math: Writing: Composite:
2 Critical Reading: Math: Writing: Composite:
*You are not required to send your SAT/ACT test scores, but if you have taken either assessment, please submit a
copy of your test scores or request that your scores are included on your high school transcript.COLLEGE OPPORTUNITIES PROGRAM: APPLICATION WORKSHEET
Page 3
STEP 3: Financial Information
GENERAL QUESTIONS
* 1. Are you currently working and getting paid? Yes No
If Yes, where?
How many hours per week?
What was your gross income? ☐ Under $1,000
(Select One) ☐ $1,000-$3,499
☐ $3,500-$7,000
☐ Over $7,000
* 2. Do you or your family receive any form of public Yes No
assistance? (i.e., AFDC, DHS, Hawai'i Housing, etc.)
* 3. Do you receive any benefit/support for Yes No
yourself? (i.e., social security, child support, etc.)
If Yes, what type of benefit/support?
How much per month?
4. Check here if you are unclear about your
family's benefit, but know your family receives Not sure
some type.
* 5. Do you have the approval of your family to
Yes No
enter COP and reside at UH Mānoa?
6. Do you personally want to live on the UHM
campus in a coed residential hall during the Yes No
summer?
* 7. Do you personally want to live on the UHM
campus in a coed residential hall during the Yes No
first academic year?
FINANCIAL INFORMATION
*
#:
1. Please indicate your family size.
Number of individuals in the This should include you and your parents/guardians and
family. anyone in the household who receives at least half of their
support from your parents/guardians. Also include siblings who
may be living away from home while attending college.
* 2. Did your parent(s)/guardian(s) file their 2019
Yes No
Federal Income Tax Return?
If Yes, what was their adjusted gross income
$
(AGI)?
If No, please explain.
* 3. Please indicate your family's estimated 2020
$
annual income?COLLEGE OPPORTUNITIES PROGRAM: APPLICATION WORKSHEET
Page 4
STEP 4: Family Information
PARENT 1
* Relationship to Applicant
If Other, please explain.
* Last Name
* First Name
* Current Address: Number - Street
* City
* State
* Zip Code
* Primary Phone Number
Secondary Phone Number
* Email Address
* Occupation/Employer
* Marital Status
* State of Legal Residence
* Did this person complete a bachelor's degree? Yes No
If Yes, which college did this person attend?
(indicate state and/or country)
PARENT 2
Relationship to Applicant
If Other, please explain.
Last Name
First Name
Current Address: Number - Street
City
State
Zip Code
Primary Phone Number
Secondary Phone Number
Email Address
Occupation/Employer
Marital Status
State of Legal Residence
Did this person complete a bachelor's degree? Yes No
If Yes, which college did this person attend?
(indicate state and/or country)COLLEGE OPPORTUNITIES PROGRAM: APPLICATION WORKSHEET
Page 5
*Recommendation form is available for download on our website.
STEP 5: Recommendations Please allow your recommenders at least 2 weeks to complete your
recommendation form and inform them it is due to COP via Dropbox
by December 2, 2020.
1. COLLEGE PREPARATORY INSTRUCTOR
* Name
* Course Taught
* School
* Phone
* Email Address
2. GRADE LEVEL OR COLLEGE & CAREER COUNSELOR
* Name
* Title
* School
* Phone
* Email Address
REFERRAL
(Who informed you about COP?)
* Name
Relationship
School/Organization
STEP 6: Personal Essay Questions
Write your essay prior to starting the online application and cut/paste your responses to each of the seven
essay questions. There is a maximum 1,000 characters per question.
1. Describe your current living situation and family members.
• Where do you live and with whom?
• How many people are in your household.
• Identify each member in the household by name, age, and relationship to you.
2. Share something about you and/or your family, your life experience, or your values that has shaped you
and brought you to this point.
3. Why do you want to attend UH Mānoa? What major(s) do you plan to pursue? How did you decide on
your major(s)?
4. Why are you applying to COP?
5. Are you currently, or have you been, involved in any extracurricular activities at school and/or in your
community? If yes, please explain.
6. In the event that you are not selected, what are your alternative plans?
7. Is there any other information about yourself that you would want the reader to know? Please feel free to
share.
Note: Your essay will be screened by a selection committee. The selection committee will be reading and rating your personal essay to
determine your eligibility and motivation for the COP program.You can also read
