Stay Maui Nui- Application - Summer 2024 
Youth Career Exploration Program for Maui County Students.

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Email *
Student Name (First and Last, Nickname) *
Which Program Week Session are you applying to? *
Student Email *
Student Phone Number *
Parent/Guardian Name *
Parent/Guardian Email *
Parent Phone Number *
Physical Address where Student lives *
Student Date of Birth *
Grade in School at the Start of Fall 2024 *
School Student will be attending in Fall 2024 *
Gender *
Has the Student taken a Career Assessment? *
If yes, the Student has taken a career assessment, what were the results, and does the Student like the results? *
What career paths are the Student interested in learning more about? *
What activities is the Student involved in, both in and out of school? Hobbies or Interests? *
Does the Student have allergies or dietary restrictions? If yes, please explain. *
Does the Student take any medications that we should be made aware of? *
Tell us about yourself (or of the Student) that will help in knowing your/Student needs. *
Do you or the student have any specific goals in participating in the Stay Maui Youth Program? *
Is the Student able to attend all the program meeting days and times? If not, please explain.
Mon-Thu 8:30am to 4:30pm and Fri 8:30am to 6:30pm
Does the student have transportation to and from: the YMCA for Maui Students, Kaunakakai for Molokai students, or Lanai City for Lanai students? *
Both the student and the student's Parent or Legal Guardian are aware of the submittal of this application?
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How did you hear about the Stay Maui Program? *
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