Talent Search Application

Talent Search, Murray State University

256 Blackburn Science, Murray KY 42071 / PHONE: 270-809-3526 FAX: 270-809-5761
Please complete all sections of the application, including all required signatures. The Talent Search program at Murray State University is 100% funded with federal funds from the U.S. Dept. of Education. All information is strictly confidential and only used by program staff.
STUDENT INFORMATION:
Student Name*

First nameLast name
Preferred Name
School*

Carlisle CountyChristian CountyFulton CountyFulton IndependentHickman CountyHopkinsvilleMayfield IndependentPaducah PublicTodd CountyTrigg County
Grade level for Fall 2024*

6th7th8th9th10th11th12th
Age:*
Gender:*

MaleFemalePrefer not to respond
Preferred pronouns

She/Her/HersHe/Him/HisThey/Them
Birthdate*

MonthDayYear
Date
Street address:*
City and state:*
Zip code:*
Home phone (include area code):*
Cell phone:*

OK to send text messages
Cell phone (include area code):*
Are you a U.S. citizen?*

YesNo (If no, you must answer the next question)
Are you a permanent citizen?

Yes (If Yes, provide the information below)No
Permanent resident number:
Are you Hispanic / Latinx?*

YesNo (If No, see below)
If NO, please select one or more options listed below:*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other pacific IslanderWhiteTwo or more racesUnknownPrefer not to answer
If you are a high school student, what is your grade point average (using a 4.0 scale)?
If you are a high school student taking rigorous coursework, mark the type of classes you are taking (choose all that apply):

Advanced Placement (AP) coursesHonors coursesDual-credit coursesCollege prep coursesOther
If you are a middle school student, what kind of grades do you typically make in school?

Mostly A'sA's and B'sMostly B'sB's and C'sMostly C'sD's or lower
Are you currently a member of TRIO Upward Bound or Upward Bound Math & Science?*

YesNo
Who referred you to our program?*
How did you hear about our program?*

social media or internetrecruitment packet mailed to meflyer at school or in communityreferred by someoneOther
PARENT / GUARDIAN INFORMATION:
Parent / Guardian 1 Name:*
Address:*
City, State:*
Zip code:*
Home/ cell phone:*
Home/ cell phone:*

OK to text
Email address:*
example@example.com
Relationship to student:*
Parent / Guardian 2 Name:*
Address:*
City, State:*
Zip code:*
Home/ cell phone:*
Home/ cell phone:*

OK to text
Email address:*
example@example.com
Relationship to student:*
Student lives with:*

both parentssingle parent (mother)single parent (father)parent and step-parentadoptive parentsother (family guardian, etc.)
Does the student have a court-appointed legal guardian?*

YesNo
Does the student have a family guardian (NOT court-appointed) with educational / medical rights for the student?*

YesNo
Is the student in a foster care program?*

YesNo
Does the student and their family qualify as homeless?*

YesNo
Was the student/family displaced from permanent housing as a result of December/January storms?

YesNo
As a result of the December/January storms, is the student/family living in temporary housing (ex. state park lodging, camper, etc.), living with other family members, or "couch-surfing"?

YesNo
FIRST GENERATION STATUS:
Does the student's FATHER have a 4-year college degree (B.A. or B.S.)?*

YesNo
Does the student's MOTHER have a 4-year college degree (B.A. or B.S.)?*

YesNo
INCOME ELIGIBILITY: PLEASE COMPLETE ALL PARTS.
How many people are in the family household?*
What was the total income for the household in 2023? *
Did your parent/guardian file a tax return in 2023?*

YesNo
If you answered YES, fill out section A. If you marked NO, fill out section B.
SECTION A: What is the TAXABLE income on your 2023 taxes? This is NOT the same as your gross (or total) income. Taxable income is found on line 43 of form 1040, line 27 of Form 1040A, or line 6 of form 1040EZ. Please check the box below that represents the 2023 taxable income on your parent/guardian tax documents. Put n/a if you did not file taxes:*
Which of these options best describes your standard deduction you selected on your 2023 tax return?*

Single taxpayerMarried filing jointlyHead of householdI did not file taxes for 2022.
SECTION B: Complete this section if you did not file income taxes in 2023. Did your household receive any of the following sources of support in 2023? If this section is not applicable to you, please check the first box. (Check all that apply):*

Not applicableVeteran's benefitsAid to Families with Dependent ChildrenUnemployment benefitsDisability benefitsFood stamps/ SNAPSocial security benefitsOther
What is the yearly total for 2023 of these benefits that you marked above? You must provide a dollar amount for this section if you did not file taxes.*
NEEDS ASSESSMENT:
Which needs can Talent Search help you with this year? (Check as many as apply):*

information about colleges / universities / technical schoolsfinancial aid application assistancecollege admissions informationcareer exploration / assessmentstudy / test-taking skillscollege/career/cultural field tripsmentoringfinancial aid informationSAT/ACT registration / preparationcollege transition informationacademic advisingonline tutoringleadership skillsfinancial literacyscholarship information / searchchoosing a college major
AUTHORIZATIONS AND SIGNATURES:
AUTHORIZATION TO OBTAIN AND UTILIZE IMAGES –By signing below, the parent/guardian of the student applicant hereby grants permission to MSU Talent Search to photograph and/or videotape either the adult parent/guardian or the minor child upon admission into MSU TS. The parent/guardian also authorizes MSU TS to use and/or permit others to use the aforementioned images in educational, informational, and promotional activities for MSU TS without compensation.

AUTHORIZATION TO RELEASE ACADEMIC / EDUCATIONAL INFORMATION – The parent/guardian authorizes the student’s schools to release any academic/educational information from the student’s files that are requested by MSU TS and authorizes MSU TS to release academic/educational information to assist in the student’s education.

I agree to the above statements and verify that by signing this document and submitting the requested documentation that the income and personal information which I have provided is accurate to the best of my knowledge. I understand that the information will be held in complete confidence by the Talent Search program at Murray State University.
Student Signature:*

Clear
Date:*

MonthDayYear
Date
Parent/Guardian Signature:*

Clear
Date:*

MonthDayYear
Date
Should be Empty:

Talent Search, Murray State University

STUDENT INFORMATION:

PARENT / GUARDIAN INFORMATION:

FIRST GENERATION STATUS:

INCOME ELIGIBILITY: PLEASE COMPLETE ALL PARTS.

NEEDS ASSESSMENT:

AUTHORIZATIONS AND SIGNATURES: