TRIO TALENT SEARCH APPLICATION

TRIO TALENT SEARCH APPLICATION
Please return this application to: TRIO Talent Search, Southwestern Community College - 1501 W. Townline St. - Creston, IA 50801 - 1-800-247-4023 (ext.392)

To be completed by the STUDENT:
Name*

First Name (PLEASE PRINT)Middle InitialLast Name
Address:*
City:*
State:*
Zip Code:*
School:*
Current Grade:*
Current GPA (HS only):
Date of Birth:*

MonthDayYear
Date
Age:*
Gender:*

MaleFemale
Home Phone:
Student's Cell:*
(Participants 7th -12th will be added to our text message system)
Student's E mail:*
example@example.com
Referred By:
Academic need: (Select at least 1)*

Goal Setting & Self EsteemLeadership SkillsStudy & Test Taking SkillsWays to Pay for CollegeCommunity Service OpportunitiesCollege VisitsACT Test PrepAcademic AdvisingCareer ExplorationCollege Exploration
Ethnicity:*

Hispanic or LatinoNot Hispanic or LatinoESL/ELL Student
Race:*

American Indian or Alaska NativeAsianWhiteBlack or African AmericanNative Hawaiian or Pacific IslanderBi-racial
I plan to go to college:*

2 years (Associate's degree)4 years (Bachelor's degree)
First and last names of parents or guardians that I live with:*
Current extracurricular activities:
To remain in the TRIO Talent Search program, participants must maintain a 2.0 GPA and regularly attend school meetings with their TRIO Talent Search advisor.
Signature
TRIO Talent Search is 100% funded by the United States Department of Education and is hosted by Southwestern Community College. Funding for 2023-2024 is $455,783.00.
TRIO EDUCATIONAL TALENT SEARCH (ETS) at SWCC is a FREE, educational program designed to assist 6th through 12th grade participants in their preparation for enrollment into ANY COLLEGE of their choice. All information on this application is confidential; your information will NEVER be shared with anyone outside of the Educational Talent Search office.
STAFF USE ONLY:

AcceptedWait List
STAFF USE ONLY:

LIFGBONEI
Director's Initials:
Date:

MonthDayYear
Date
Advisor's Initials:
Revised
To be completed by PARENT/GUARDIAN:
First Name:*
(1) Parent/Guardian
Last Name:*
(1) Parent/Guardian
Relationship to child:*
Employer and/or Occupation:
First Name:
(2) Parent/Guardian
Last Name:
(2) Parent/Guardian
Relationship to child:
Employer and/or Occupation:
Marital Status:*
Total Number of people in your household:*
Parent/Guardian Email:*
example@example.com
Please add me to text messaging system
Phone/Cell Number:*
Father GRADUATED from 4-YEAR College or University?*

NoYes
Where from:
Does child regularly reside with Father?

YesNo
If "other" please explain.
Mother GRADUATED from 4-YEAR College or University?*

NoYes
Where from:
Does child regularly reside with Mother?

YesNo
If "other" please explain
Child's Name:*
Student is currently in foster care or a legal ward of the state?*

NoYes
Is your child a U.S. Citizen?*

NoYes
Permanent Resident Card # USCIS:
The Talent Search program offers FREE services to assist students who have the potential to succeed in higher education. The program hosts:
- Monthly In-school Fun & Interactive Meetings
- Academic Tutoring at Various Locations
- College Campus Visits & Cultural Events staffed at a 1:10 ratio (1 adult for every 10 students)
- Workshops and Curriculum on the following topics: Study Skills, Goal Setting, Career Decision Making, Rigorous Course Scheduling, Choosing a College, The College Application Process, ACT Registration & Test Prep, Writing a Scholarship Easy, and How to Pay for College.
My child may participate fully in all Talent Search services listed above:*

NoYes
If no, please explain why and whether there are aids/services that could enable the student to participate:
I believe my student will:*

not attend collegeobtain a 2 year degreeobtain a 4 year degree
TAXABLE INCOME AMOUNT This is NOT your gross income but your net income AFTER payroll deductions It can be found on your IRS Form 1040 Line 15 (see below image).*

$0-$23,940$23,941-$32,460$32,461-$40,980$40,981-$49,500$49,501-$58,020$58,021-$66,540$66,541-$75,060$75,061-$83,580Over $83,581
If you did not file a Federal Income Tax return last year, does student qualify for free lunch program:*

NoYes
Do you have other children in grades 6-12 that would like to apply for TRIO Talent Search?
Name:
School:
Grade:
TRIO TALENT SEARCH RELEASE OF INFORMATION

I give my consent for the TRIO Talent Search Program to request information from the school (which may include school transcripts, standardized test scores, grade reports, income and/or other benefit receipts) necessary to document eligibility of the applicant throughout participation in the SWCC TRIO Talent Search Program. I also give consent for the TRIO Talent Search Program to share information with other agencies offering student support services and for the TRIO Talent Search Program to transport my student to workshops, seminars or college visits, sponsored by the program (events are staffed at 1:10 ratio Additionally, I understand that my student may be photographed/videotaped while participating in program activities and I agree that photographs/videos may be used in various social media to promote the program to other students, parents and institutions.
Parent/Guardian Name (Printed)*
Parent/Guardian Signature*
Date

MonthDayYear
Date
Should be Empty: