Name of Person that referred you
Student First Name
Student Last Name
Social Security Number (if DACA or Other write NA)
U. S. Citizen
Date Picker Icon
May we text you?
Prefer not to say
Native Hawaiin/Pacific Islander
Are you of Hispanic/LatinX Ethnicity
Name of School for the 2021-2022 Academic Year (next school year)
School ID Number (if unknown write unknown)
Grade Level (this past 2020-2021 year)
8th Grade -
9th - Freshman
10th - Sophomore
11th - Junior
12th - Senior
Are you enrolled in a Dual Enrollment Program
Are you enrolled in any of the following programs:
Do you use any of the following social media?
What is your parent/guardian full name?
Parent Cell Number
May we text your parent?
Parent's email address (if none, write none or na)
What is the marital status of your parents/guardian?
Do either of your parents have a degree from a four (4) year U.S. college?
Please check the taxable income that best describes your family income (This is Adjusted Gross Income after deductions)
Less than $19,320
Between $19,321 and $26,130
Between $26,131 and $32,940
Between $32,941 and $39,750
Between $39,751 and $46,560
Between $46,561 and $53,370
Between $53,371 and $60,180
Between $60,181 and $66,990
More than $66,991
How many family members live at home?
What is the grade level of your siblings that live at home with you
Please upload transcript or most recent report card (a picture will do if unable to scan)
Do you require any specific Accessibilty measures to be taken in order for you to comfortably participate in a Zoom webinar (i.e. live caption)
I am the student and I agree to the consent to the release of my academic records, personal identifying information, test scores, free/reduced lunch, college enrollment info, FAFSA information to LNESC for the purposes of determining eligibility for services to the US Dept of Education Talent Search Program per FERPA guidelines.
I am the parent/legal guardian and agree to the consent to the release of my/my child's academic records, personal identifying information, test scores, free/reduced lunch, college enrollment info, FAFSA information to LNESC for the purposes of determining eligibility for services to the US Dept of Education Talent Search Program per FERPA guidelines. I agree to provide a copy of my personal income tax upon request
I am interested in the following (check all that apply)
Summer Showcase Series (9th-12th grade ONLY)
Prep SAT/ACT Classes (Free)
Shell Science Corp After School Program
What are your educational goals?(check all that apply)
Receive High School Diploma
Receive an Associates Degree (2-yr college degree)
Receive a Bachelors Degree (4-yr college degree)
Receive a Masters Degree
Receive a Professional Degree (Law School/Medical School/Dental/Optometry/Pharmacist, etc)
Join the Military
Enter the workforce
What type of career would you like to pursue?
List colleges you are interest in attending or receiving information
If you don't want to go to college, check all that apply
College is too expensive
I don't want to be in debt with college loans
I'll make more money if I get a job
My parents don't want me to go to college
I won't qualify for financial aid
My parents can't afford to pay college my tuition
College will be too hard; too much work
No answer/Not applicable
If you are under 18 years of age do you plan on registering to vote once your turn 18?
N/A (doesn't apply to me)
If you are 18 years of age or older are you registered to vote?
N/A (doesn't apply to me)
How do you receive news/current events
Social media (Facebook, Twitter, etc)
What television station do you watch the most?
How do you listen to music?
Local radio stations
What radio station do you listen to the most?
What language is spoken in you home?
List 2 current issues that concern you the most about the state of the world
Check all the local LatinX Elected Officials you have heard about
United States Congresswoman Sylvia Garcia
Texas Senator Carol Alvardo
Texas State Representative Ana Hernandez
Texas State Representative Armando Walle
Texas State Representative Mary Ann Perez
Texas State Representative Christina Morales
County Judge Lina Hidalgo
County Commissioner Adrian Garcia
Sheriff Ed Gonzalez
City Councilman Robert Gallegos
City Councilman Karla Cisneros
School Board Judith Cruz
School Board Dani Hernandez
Should be Empty: