LNESC Talent Search Program Student Application

Email address*
Student First Name*
Middle Name
Student Last Name*
Social Security Number (if DACA or Other write NA)*
Citizenship*

U. S. CitizenPermanent ResidentDACAOther
Street Address*
City*
State*
Zip Code*
Birthdate*

MonthDayYear
Age*
Cell Number*
May we text you?*

YesNo
Sex*

MaleFemalePrefer not to sayNon-BinaryOther
Are you of Hispanic/LatinX Ethnicity*

YesNo
Race:*

WhiteAfrican-AmericanAsianNative-AmericanNative Hawaiin/Pacific IslanderOther
Name of School for the 2021-2022 Academic Year *
School ID Number (if unknown write unknown)*
Grade Level*

5th Grade (summer before 6th grade)6th Grade7th Grade8th Grade -9th - Freshman10th - Sophomore11th - Junior12th - SeniorCollege
Are you enrolled in a Dual Enrollment Program*

YesNo
Are you enrolled in any of the following programs:*

Upward BoundEmergeQuest BridgeGear UPTalent SearchProject GradNone/NA
Do you use any of the following social media?*

FacebookTwitterInstagramSnapChatNoneOther
What is your parent/guardian full name?*
Parent Cell Number*
May we text your parent?*

YesNo
Parent's email address (if none, write none or na)*
What is the marital status of your parents/guardian?*

MarriedSeparatedDivorcedSingleWidowed
Do either of your parents have a degree from a four (4) year U.S. college?*

YesNo
Please check the taxable income that best describes your family income (This is Adjusted Gross Income after deductions)*

Less than $19,320Between $19,321 and $26,130Between $26,131 and $32,940Between $32,941 and $39,750Between $39,751 and $46,560Between $46,561 and $53,370Between $53,371 and $60,180Between $60,181 and $66,990More than $66,991Other
How many family members live at home?*
What is the grade level of your siblings that live at home with you*

Elementary6-8th Grade9-12th GradeCollege Studentnone/na
Please upload transcript or most recent report card (a picture will do if unable to scan)

Browse Files

Cancelof
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)

YesNo
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.*

YesNo
Student Signature*

Clear
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*

YesNo
Parent Signature*

Clear
Student Questionnaire
I am interested in the following (check all that apply)*

Summer STEM Program (6th-8th grade ONLY)FAFSA AssistanceScholarship OpportunitiesCommunity ServicePrep SAT/ACT Classes (Free)Essay Review/AssistanceShell Science Corp After School ProgramCollege Field TripsOther
What are your educational goals?(check all that apply)*

Receive High School DiplomaReceive an Associates Degree (2-yr college degree)Receive a Bachelors Degree (4-yr college degree)Receive a Masters DegreeReceive a Professional Degree (Law School/Medical School/Dental/Optometry/Pharmacist, etc)Join the MilitaryEnter the workforceOther
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 expensiveI don't want to be in debt with college loansI'll make more money if I get a jobMy parents don't want me to go to collegeI won't qualify for financial aidMy parents can't afford to pay college my tuitionCollege will be too hard; too much workNo answer/Not applicableOther
If you are under 18 years of age do you plan on registering to vote once your turn 18?*

YesNoN/A (doesn't apply to me)
If you are 18 years of age or older are you registered to vote?*

YesNoN/A (doesn't apply to me)
How do you receive news/current events*

Local newsLocal newspaperInternetSocial media (Facebook, Twitter, etc)
What television station do you watch the most?*
How do you listen to music?*

Local radio stationsSpotifyPandoraApple musicOther
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 Latino/a Elected Officials you have heard about*

United States Congresswoman Sylvia GarciaTexas Senator Carol AlvardoTexas State Representative Ana HernandezTexas State Representative Armando WalleTexas State Representative Mary Ann PerezTexas State Representative Christina MoralesCounty Judge Lina HidalgoCounty Commissioner Adrian GarciaSheriff Ed GonzalezCity Councilman Robert GallegosCity Councilman Karla CisnerosSchool Board Judith CruzSchool Board Dani HernandezNone/don't know

FOR OFFICE USE ONLY:

Student Questionnaire

FOR OFFICE USE ONLY