TRIO Talent Search Application

Talent Search

Student Application
Instructions for completing this form:
1. Read each question carefully and complete all sections.
2. If you fail to answer all necessary questions and/or omit signatures, your application will be returned to you for completion.
3. Students cannot participate in program activities until all application materials are complete and returned.
Name*

First NameLast Name
Grade*
Social Security Number*
No spaces, only numbers.
Birthdate*

MonthDayYear
School ID #*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student Cell Phone Number*

Area CodePhone Number
Student Email*
example@example.com
Gender*
Ethnicity*
Are you a US Citizen?*

YesNo
Do you have a computer with internet access at home?*

YesNo
Parent/Guardian Information
Guardian's Name*

First NameLast Name
Relation to child*

MotherFatherGrandparentGuardianOther
Phone Number*

Area CodePhone Number
Email*
example@example.com
Has Guardian received a 4-year degree?*

YesNo
If yes, name of college/university
Guardian’s Name

First NameLast Name
Relation to child

MotherFatherGrandparentGuardianOther
Phone Number

Area CodePhone Number
Email
example@example.com
Has Father/Guardian received a 4-year degree?

YesNo
If yes, name of college/university
The following financial statement is needed by the Department of Education to prove income status, so that your student can participate in the program.
Number of people living in your household *
What is your yearly household income?*
Media Publication and Release Authorization

I hereby grant Talent Search of BGCTNV full and absolute permission to publish, display, and use of photographs, together with descriptive test or statements, in which I or my child appear.
Parent/Guardian's Signature

Clear
Date*
Student Individual Needs Assessment
What are your plans after high school? *

Attend a 4-year college / universityJoin the militaryAttend a community collegeAttend a trade / technical schoolWork full timeI am not sure of my plans yet
What subjects do you struggle with?*

MathScienceEnglishHistoryForeign LanguageOther
What careers interest you?*
In which of these areas listed do you need assistance? (please check all that apply) *

Academic assistance and AdvisementCollege Awareness and Admissions AssistanceFinancial Aid Information and Application AssistanceCareer Awareness and ExplorationEconomic and Financial LiteracyOther
Participant Confidentiality and Release of School Records
The Talent Search Program of Boys & Girls Clubs of the Tennessee Valley will maintain all student ﬁles in a conﬁdential manner. Pertinent information (i.e. all academic information, report card information or tutorial information) may be shared professionally with Talent Search staff members, or the school system child attends. Files for all programs funded in whole or in part by the Department of Education are available for monitoring and subject to audit by the Department of Education. Communication of student information to persons or agencies other than those listed above will require express written approval of the student’s parent.

A Talent Search staff person has explained the above information, regarding the release of information in my students file maintained by Talent Search of BGCTNV to me. I agree to the release of information to persona or agency as listed above. I understand that any release of information to personas or agencies other than those mentioned above will require my written approval
Student*

First NameLast Name
School*
Parent's Signature*

Clear
Date*
I (We) understand that Talent Search will use the data provided on this form to assist in assessing any academic or career planning needs and that all of the information will be used in the strictest of confidence. I certify that all information provided is correct to the best of my knowledge.
Parent's Signature*

Clear
Student's Signature*

Clear
Date*
Federally funded by the Department of Education
Should be Empty:

Talent Search

Parent/Guardian Information

Student Individual Needs Assessment

Participant Confidentiality and Release of School Records