Kea'au High School 2021 Summer Bridge Program Application & Consent Form
We are accepting virtual signatures (ex. typing your name when asked for consent) as fomal signatures as they relate to this official application document. Please fill out and answer all questions in their entirety. Mahalo!

This organization does not tolerate any form of discrimination, harassment, or bullying because of a student's race, color, national origin, disability, sex, age, gender identity and expression, socio-economic status, physical appearance, sexual orientation, and/or religion.
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Student Last Name *
Student First Name *
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Previous School *
Home/Physical Address *
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Zip Code *
Home Phone Number *
Mailing Address (if different from home address) *
City *
Zip Code *
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