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  • Minority Access, Inc. Educational Talent Search Program

  • 5214 Baltimore AVE, Hyattsville, MD 20781| Phone: 301.779.7100 

  • PARTICIPANT APPLICATION

  • This information will be held in strict confidence and will not be used for any other purpose or released to any other agency. The Educational Talent Search Program hosted by Minority Access, Inc. is charged with developing and administering a pre-college orientation program offering academic support, college admissions assistance, career exploration, financial literacy, and financial aid information. Our objective is to impress upon the participants that college is a necessary and attainable goal so they may take charge of their academic achievement to reach their full potential. All program services are provided free of charge. Educational Talent Search is grant-funded by the U.S. Department of Education. All information is strictly confidential and is used solely to determine program eligibility. 

  • STUDENT INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

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  • Gender*
  • Citizenship Status*
  • Racial Information*
  • Ethnicity Information*

  • FAMILY INFORMATION

  • 1. Is the student a foster child or ward of the court?*
  • 2. Does the student have a diagnosed learning or physical disability?*
  • 3. Has either Parent/Guardian earned a 4-year degree?*
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  • 4. Household receives one or more of the following as its only source of income: (1) Workers Compensation (2) Veteran’s benefits (3) SS or SSI (4) Disability (5) Welfare benefits*
  • 6. Parents/legal guardians select your Annual Household Adjusted Gross Income Range*

  • AGREEMENT STATEMENT

  • By signing this application, I (the parent or guadian) attest that all the information on this application is true and accurate to the best of my knowledge. Moreover the parent or guardian agrees that:

  • Please select all that apply.
  • My child is in need of or desires the academic preparedness and college awareness services of ETS.*
  • The student does not participate in any other TRiOProgram such as Upward Bound or College Park Educational Talent Search Program?*
  • If accepted into the program, I will meet with my academic advisor at least once each semester and notify the program of my contact*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • DOCUMENTATION / MARKETING / PROMOTIONAL RELEASE

  • My/Our signature(s) at the end of this application hereby authorizes the use of my child's personally identifiable information and photos to be used by the Educational Talent Search Program (ETSP) for postsecondary planning on behalf of my child and for the following purpose(s): annual report, marketing, fundraising, and promotional public relations. This information may include official transcripts, quarterly grade reports, progress reports, course schedules, standardized test scores, eligibility, name of current school, name of current institution of higher education, financial awards, and any materials and resources relative to my child's academic performance. This information may be used now and throughout the duration of their participation in the Educational Talent Search Program and through their first year of postsecondary education. All photos of student participants in the program become the property of ETSP.

  • SAFETY AND SUPERVISION

  • The Educational Talent Search Program (ETSP) is a learning environment that promotes safety and a drug-free environment that is conducive to learning. The program respects the rights of students to be treated equally and fairly to ensure that no student is discriminated against based on race, color, sex, age, national origin, religion, sexual orientation, or disability, procedural in the area of freedom of expression and due process, personal rights and access to program services. The focus on student safety is considered at each sponsored event. Thus, parent(s) and school officials are requested to assist in the supervision efforts of the student to ensure adequate supervision. Students registered for any ETSP-sponsored activity are restricted to the premises of the activity. Upon completion and dismissal of the activity, parents are required to pick up their child promptly. The Parent/Guardian acknowledges that the program, its entities, and agency affiliates assume no responsibility for students whose parents are not present to receive them. No exceptions.

  • PARENTAL CONSENT FORM FOR RELEASE OF EDUCATIONAL RECORDS

  • The Family Educational Rights and Privacy Act (FERPA) generally protects students' privacy interest in their education records. This law prohibits sharing educational information concerning a student with individuals who are not school officials without parental consent. As a condition of eligibility for membership in the Educational Talent Search Program (ETSP), I hereby consent to the release of, copying, and discussing my child's academic school record, including standardized test scores, quarterly and final report card, to the ETSP staff, including the individual tutor to be assigned to work with my child, for the entirety of my child's participation in ETSP. This authorization and consent shall be valid until my child graduates from high school or throughout postsecondary and beyond.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
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