Application for Talent Search | Educational Talent Search

"*" indicates required fields

Southern Arkansas University
100 E University
MSC 9277 Magnolia, AR 71753-9277

Name*

First Last

Date of Birth*

Social Security Number*

Please enter a number from 000000000 to 999999999.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Emergency Contact*

First Last

Emergency Contact Phone

School*

Grade Level*

Age*

Please enter a number from 10 to 20.

Gender*

Are you a United States citizen?*

Yes

Alien Registration Number*

Ethnicity (check all that apply)*

White/Caucasian

Hispanic/Latino

Native Hawaiian/Pacific Islander

Black/African American

Asian

Other (please specify)

Other Ethnicity*

Student lives with:

Single Parent

Both Parents

Guardians

Grandparents

Step Parent

Other

Other household type*

Which best describes your grades?*

Are you enrolled in a TRiO program?*

Yes

Listed below are some possible Educational Talent Search activities. Check the area(s) with which you would like information or need help with:*

College Awareness (Admission, Financial Aid, Campus Tours, Scholarship Information, ACT Information)

Career Awareness (Career Planning, Goal Setting, Interest Inventory, Guest Speakers, Decision Making)

Academics (Study Skills, Test-Taking Skills, Time Management, Course Selection)

Character Development (Peer Pressure, Self-Esteem, Bullying, Cultural Experience, Listening Skills)

Tutoring (Math, English, Science, Social Studies)

Other (please list)

Other activities for which you would like information or need help with:*

Which do you plan to enroll in after completing high school?*

College/University (4 year)

Community College (2 year)

Career Training Program

Military Program

Undecided

In order to participate in Educational Talent Search I agree to: maintain a 2.0 or better GPA to remain in the program; attend and participate in all scheduled meetings, workshops, tutoring, or mentoring sessions; have a desire to go to college; refrain from having discipline/behavioral problems; have respect for self and others; successfully be promoted to next grade; attend school regularly; seek help with academic or personal problems; and enroll in post-secondary program after graduation.

By checking this box I, as student, am providing an electronic signature that I have read the above statement and agree to its terms.

For my child to remain eligible to participate in Educational Talent Search, I will: immediately notify an Educational Talent Search Counselor if my child receives disciplinary action at school; be involved with Educational Talent Search activities as much as possible; attend at least one parental workshop provided by Educational Talent Search; and notify the Educational Talent Search office about any changes in contact information.

By checking this box I, as parent, am providing an electronic signature that I have read the above statement and agree to its terms.

Mother's Name*

First Last

Mother - Legal Status*

Parent (biological or adoptive)

Guardian

Mother's Phone Number*

Mother's Email

Mother's Employer*

Mother's Highest Education Level Completed*

High School/GED or lower

Associate Degree (2 year)

Bachelors Degree (4 year) or higher

Father's Name*

First Last

Father's Employer*

Father - Legal Status*

Parent (biological or adoptive)

Guardian

Father's Phone Number*

Father's Email

Father's Highest Education Level Completed*

High School/GED or lower

Associate Degree (2 year)

Bachelors Degree (4 year) or higher

Total number of family members living at home (including applicant):*

Check the following services which your family receives:

Free School Lunch

Reduced Lunch

Did you file a Federal Tax Return last year?*

Yes

Please indicate your Taxable Family Income from last year after deductions. This in not your Adjusted Gross Income. (found on Form 1040 - line 43; Form 1040A - line 27; and Form 1040EZ - line 6)*

This field is hidden when viewing the form

Please indicate your Taxable Family Income from last year after deductions. This in not your Adjusted Gross Income. (found on Form 1040 - line 43; Form 1040A - line 27; and Form 1040EZ - line 6)

I/We declare that no federal tax income was filed for the last tax period because my gross income was insufficient to require filing. Please check your form of income:*

Disability

Retirement

Unemployment

Child Support

Social Security

Veterans Benefits

Welfare/Social Services

Aid to Families with Dependent Children (AFDC)

Other

Parent Consent and Information for Student Participation in Educational Talent Search (ETS)

I am aware that my child has shown interest in the program.
I hereby authorize TRiO Educational Talent Search Program to contact and request information from, as well as share information with my child's school, teachers, and counselors. I hereby grant permission for he release of my child's high school records, transcripts, and all other achievement records to the Southern Arkansas University Educational Talent Search Program.
I grant permission to the Educational Talent Search Program to treat (over the counter medication) to my son/daughter for any minor illness that they may encounter while at an Educational Talent Search sponsored event.
I give permission to the Southern Arkansas University Educational Talent Search Program to arrange transportation for my son/daughter, to and from Educational Talent Search sponsored events, in vans, buses, or other vehicles driven or arranged by the Southern Arkansas University Educational Talent Search Program and seek medical assistance in the case of an accident.
I give my son/daughter permission to be interview and/or photographed by digital, still photo film, or video recorder by Education Talent Search Program to use on radio, TV, printed media, social sites, or in project documentation and promotional materials.
Our signatures below indicate our commitment to the TRiO Educational Talent Search Program. I consent to my child using the Internet and other technology and accept responsibility for appropriate use thereof.
I understand that Education Talent Search is a federal program authorized by the U.S. Department of Education. I also understand that the information I have provided will be used to document my eligibility for the Educational Talent Search Program. I understand that the information provided on this application will be held confidential by the ETS staff.

Parent Consent and Information for Student Participation in Educational Talent Search (ETS)*

By checking this box I, as parent, am providing an electronic signature that I have read the above statement and agree to its terms and certify that all the information I have provided on this form is true and accurate.

Parent Consent and Information for Student Participation in Educational Talent Search (ETS)

Schools & Colleges

Quick Links

Social