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Upward Bound Electronic Device Request
Please fill out all the questions in the form in order to secure your spot on the waiting list for specific electronic device. All electronic devices will be distributed to use for ACADEMIC or UB USE ONLY (no personal use allowed). Upon submission of this request form, you (the student) and your parent/guardian will be contacted by UB. Devices will be distributed on first-come and need basis. We will check on you and the devices. If you have any questions, please contact us at
ubmaui@hawaii.edu
. Thank you!
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* Indicates required question
Email
*
Your email
What is your MAILING address (Hana, Lahaina, Molokai, Hana, Pukalani Students) If you cannot pick up.
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Who is your advisor?
*
UBO/ Aunty Lala or Aunty Beth
UBMS/ Aunty Krissy
UB/ Jesse or Aunty Nasi
Aunty Suli Molokai
Grade
*
9th
10th
11th
12th
High school
*
Baldwin High School
Hana High School
King Kekaulike High School
Lahainaluna High School
Lanai High School
Maui High School
Molokai High School
Other:
What device or devices do you need?
*
Please notify your advisor prior to requesting a webcam, WiFi Extender, and/or a Hot Spot.
Chrome Book
Go Pro
Canon Camera with Recording Devices
Tri Pod
Webcam (By Request Through Advisor)
Hot Spots (By Request Through Advisor)
WiFi Extender (By Request Through Advisor)
VR Oculus System with Case and Wire (Only use at the UB office)
iPad Pro 2019 with Apple Pen (By request from Instructor or Mentor)
Raspberry PI Set
Drones
Microphone Set
Other:
Why do you need the Device and does your advisor know?
*
Your answer
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