TRIO Talent Search Student Application

Student Application

TRIO Talent Search is a 100% Federally funded TRIO Program by the U.S. Department of Education and sponsored by Madisonville Community College, an equal opportunity institution. Click the picture below for more information!
Student Information
Student's Name

First NameMiddle NameLast Name
Social Security #
All information will be held confidential and is for TRIO TS use only.
Gender
Birth Date

MonthDayYear
Grade
School
Address

Street Address

P.O. Box/Street Address Line 2

CityState

Zip Code
Student's Cell #

Area CodePhone Number
Student's Personal Email Address (Please list one you have access to.)
example@example.com
Student is a U.S. Citizen?
Student's Racial/Ethnic Background? (Check all that apply.)

Other
Parent/Guardian Information
Parent 1 Name

First NameLast Name
Relationship
Cell #

Area CodePhone Number
Place of Employment
Parent 2 Name

First NameLast Name
Relationship
Cell #

Area CodePhone Number
Place of Employment
Did student's parent(s) graduate with a 4-year or more college degree?
If yes, what is the name of the college, type of degree and the graduation year?
If this applies to more than one parent/guardian, please indicated which parent when listing colleges and graduation years.
Which option best describes student's current living situation?

Other
Please list parent/guardian occupation and position (If not applicable, list NA.).
If this applies to more than one parent/guardian, please indicated which parent when listing.
How many people live in your household?
Please list student's siblings and their grade level. (If not applicable, list NA.).
Did parent/guardian file a Federal Income Tax Report for 2025?
If yes, please look on your 2025 tax form at line 15 and indicate below your TAXABLE INCOME. (This is not the same as annual gross income.)
If no, please check all sources of income listed below.

Other
Student Need Assessment
What are your plans after high school?
Please list any careers that interest you.
Please check the TS services that interest you.

Other
Authorization to Obtain and Utilize Images

By signing below, I give permission for my child's name, photograph, video recording, work, and statements to be used by TRIO Talent Search for promotional, publicity, reporting, verification, or instructional purposes.

Authorization to Release Academic/Educational Information

By signing below, I authorize TRIO Talent Search (TS) to obtain documents relative to and consistent with my child's education. Such documents may include: transcripts, test scores, ACT/SAT scores, ILP (Individual Learning Plan), school lunch program eligibility, attendance, behavior reports, Infinite Campus, FAFSA submission summary, college admissions information and educational progress reports.

By signing below, I authorize the above releases and I certify that the information in this packet and any attachments are true, complete and accurate to the best of my knowledge.
Parent Signature
Student Agreement

By signing below, I am indicating that I would like to become a participant in the federally funded TRIO Talent Search program at Madisonville Community College and receive services provided. I will fully participate to the best of my ability and be an active TRIO Talent Search student.
Student Signature
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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