Ka Wai Ola - Office of Hawaiian Affairs, Volume 9, Number 4, 1 ʻApelila 1992 — ʻOhana self enrollment form [ARTICLE]

ʻOhana self enrollment form

0FFICE OF HAWAIIAN AFFAIRS HAWAIIAN ANCESTRY ENROLLMENT Phase I CONFIDENTIAL70FFICE USE ONLY ! INSTHUCTIONS: To be completed by adults 18 years and older o( Hawaiian ancestry and those who are less than 18 years and have children. Please I | fill out this form to the best of your ability Return to OHA Representative for final eheek. Mahalo for your kokua. ■ A.1. Inoa Piha (FULL LEGAL NAME) l35t rmsr MtooLE I # I I A.2. Birth Name I LAST 1,1, III i| FIHST MIOOLE | ! A.3. Social Security No. — — ! B.1. HeluWahi (Residence Address) I I city statc/country zip cooe . I B.2. Helu Wahileka (Mailtng Address) |

citv state/country zip cooe i | C. Helu Kelepona (Telephone Number(s) Home: □ Unlisted Business I | D. □ Kane (Male) □ Wahine (Eemale) Marital Status □ Single □ Married □ Divorced □ Widowed U Separated □ Living with | E. La Hanau (Birthdate) / / | F.1. One Hanau (Bir1hplace) I citv / islan0 state / country i j F.2. Kula Iwi I (Geographic Affin,ty) c,ty,,slano st.te,country j I G.1. Koko (Percentage of □ Less than 25% □ Q 25%-49% □ H 50%-74% □ T 75%-99% □ F 100% □ Hanai Hawaiian Blood) Check One I G.2. Other □ Am lndian, Alaskan □ Chinese □ Japanese □ Caucasian □ Filipino □ Portuguese □ Other I I H. Rootname(s) of Hawaiian Lineage is/are: lsland/Place/Ahupua'a Mother's Side ■ Grandmother I f Grandfalher I Father's Side | Grandmother I Grandfather ' | I. Living 'Ohana Haku lf Known: (Person wrth Mosl I Knowledge of 'Ohana) 515511 I ; 0 * aooaess pmone i ■ J.1. Please tist bek>w your spouse (husband or wife), parent of children and children (including children over 18. deceased. married or not living in | household) Please answer as mueh as possible I ^=___===_^==_=^^=^=^_ I

□ Husband □ Wife □ Mate Name I Birth date: /_ / % of Haw'n □ Kane □ Wahine ! A lB C | D I E I F I G | H ■ [ NAME Living in Percentage of Relationship ■ I Please Write COMPLETE Name Birthdate Sex Marital Household Deceased Hawaiian" to Applicant | j LAST FIRST Ml MO DAY YR Status YES NO YES NO (Circle One) inA.1. | PAAENT OE CM4LO(Rf N) I XXXXXX L Q H T F XXXXXXXXX | I LOHTF DSHd Hs J I LQHTF DSHdHs I | LQHTF DSHdHs f I L 0 H T F DSHdHs ' ■ LQHTF DSHdHs ■ | LQHTF DSHdHs | | LQHTF 0 S Hd Hs I | J.2. □ Check here if form tor additional names is attached. No. of additional forms: j K. □ lf other Haw'n persons living in household, please list. | A B C D E I | NAME Percentage of ■ J Please Write COMPLETE Name Birthdate Sex Hawaiian" Relationship to Applicant | LAST FIRST Ml MO DAY YR (Circle One) m A.1. I J L Q H T F Sb P Gp Gc I UA NN C N I I LQHTF Sb P Gp Gc I UA NN C N J | L Q H T F Sb P Gp Gc I UA NN C N I [ L Q H T F Sb P Gp Gc I UA NN C N | ■ L. □ For my Hawaiian ancestry, I have supporting/verifying documents ■ M. □ We have a family genealogist last fīhst mioole i I aodhess phone i | N. I hereby give permission for the use of the abovs information for genealogical purposes only. □ Yes □ No (lnitial) | I certify that the facts contained in this appiication are true and correct to the best of my knowledge and understanding. I

I | SBSrm dā7Ē I KA WAI OLA 0 OHA | km oate i I Fair lnformation Practice (Confidentiality of Personal Record) I In accordance with provisions of Chapter 92E of the Hawai'i Revised Statutes, no personal information shall be disclosed except under condition specified J I by law and in the following manner : 1 ) personai records of individual applicants shall be accessible to the owner at any reasonable time at his/her request, | ■ 2) such records shall be available to OHA staff who have direct custody of such records and who have demonstrated need to know 3) records will be I I accessibte to other individuals only at the expressed written permission of the owner . OHA shall establish appropriate administrative, technical and physical I I safeguards to ensure the securlty and confidentiality of records containing personal information relative to this enrollment procedure. oharae«,< u< i | £^CINAL_COPY \

On July 17, 1989, the Office of Hawaiian Affairs launched Operation 'Ohana, a worldwide en-. rollment program for all persons of Hawaiian ancestry. This project encourages all native Hawaiians to join together in one allianee beginning with families and expanding to include the entire community and culture.

The program will provide vital information about native Hawaiians that is needed to evaluate their needs. This is an attempt to have a comprehensive record of the Hawaiian people in one agency instead of information being scattered at so many different agencies. Genealogy, whieh will result as part of validation, will help to unite families who had no idea of their family ties. Many 'ohana reunions are occurring for this reason. Closer relationships are occurring as Hawaiians are seeking their roots. Simply fill out form, cut and mail to Office of Hawaiian Affairs, 711 Kapiolani Blvd., Suite 500, Honolulu, HI 96813. Make a copy for yourseff. If you need help or have questions to complete the form, please eall the nearest OHA office. On Oahu, eall 586-3751, or 586-3777. On Hilo, eall 9334349, Kailua-Kona 329-7368; Lihue 241-3390; Kaunakakai 553-3611, and Wailuku 243-5219.

Volunteers are also available to help with registration. In addition, on O'ahu the Honolulu Community Action Frogram district offices are also available to help. Their numbers are central district, 488-6834; Kalihi-Palama, 847-4861; Leahi, 732-7755; Wai'anae, 696-4261 and Windward, 2395754. Instructions: TYPE OR PRINT CLEARLY USING BLACK BALL POINT PEN. A-1 Last name first, then first name and full middle name. If there is a Jr. or Sr., put it after middle name. A-2 Birth name — name you were given when born. If same, print SAME. A-3 Your social security number. B-1 The address where you live.

B-2 Mailing address. If sānrie, write SAME. C. Home and business numbers. D. Check proper box for sex and marital status. E. Your birthdate. Two digits for month and day and 4 digits for year. F-1 Location of your birth. F-2 The plaee you feel kinship to or where you have your roots. G-1 Mark X in appropriate box. G-2 Mark appropriate box for other ancestry. H. Rootnames of Hawaiian lineage. Family names going back 4 or 5 generations. I. List name and address of the person with the most knowledge of your 'ohana, if there is such a person. J-1 Name of spouse, indicate whether husband, wife or mate and write birthdate, percentage of Hawaiian and sex. List children, starting with parent of the children (your spouse or ex). Last name first, first name then middle. If you have children from another marriage, please indicate father or mother's name and % of Hawaiian.

You will need to use the Additional Family Information form. Call OHA to mail you this form. % of Hawaiian coding L — less than 25% Q— 25% - 49% H— 50% - 74% T— 75% - 99% F— 100% Relationship Coding D - daughter S - son HD - hanai daughter HS - hanai son K. List other Hawaiian persons living in | household. ! Sb - sibling P - parent Gp - grandparent Gc - grandchild ; I - inlaw UA - uncle/aunt j NN - nieee/nephew C - cousin N - non L. If you have documents to support your Hawaiian ancestry, mark X. M. If there is a family genealogist, list name address and phone. N. Check box and initial if this form may be used 1 for genealogical purposes. Sign form, complete date and keep a copy. Return completed form to OHA.