TRIO Talent Search Application

Submit a TRIO Talent Search application below.

Student Information

Last Name

First Name

Middle Initial

Date of Birth (MM / DD / YYYY)

Current Age

Gender

Citizenship

If Permanent Resident, A#

If other please describe:

Student Email Address

Student Address (If different than parent(s)

Ethnicity (Select One)

Ethnicity (If more than one, list here)

Current Grade

Student is in (Select One)

Student is in (If more than one, list here)

Did you or will you get a GED? Yes No

If Yes, what month and year (MM /YYYY)

School Attending

Highest Grade Completed

(Expected) High School Graduation Year

Parent/Guardian Information

Full Name(s)

Address

City

State

Zip

Phone

Email

Does either guardian in the home have a 4 year college (bachelor) degree?

Number of Household Members

Income: I certify that my total household TAXABLE INCOME during the last calendar year was

Family receives Public Assistance? (ex: EBT, WIC, Medical Assistance, CHIP, TANF, General Assistance)

Student is ward of the court?

Student resides in foster home?

TRIO Educational Talent Search

Current College Plans

If other, please describe below

Talent Search Services Requested (Select One)

If other, or multiple, please describe/list them out

Photo Release

By selecting "Yes", if I become a participant, I do NOT give permission for my name and picture to be published. Yes No

By submitting, I certify that the information contained in this application is factually correct and complete. I understand that the omission or misrepresentation of any information will result in the above student's rejection from the TRIO Talent Search program.

Student Confirm Information Yes No

Student First and Last Name

Parent/Guardian Confirm Information Yes No

Parent/Guardian First and Last Name

TRIO Talent Search Application

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