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Educational Talent Search Student Application

School Name   Grade   Year of Graduation (yyyy)

Legal Name: Last   First   Middle 

Social Security Number   Date of Birth (mm/dd/yyyy)

Current Address:
Street / P.O. Box 

City   State   Zip 

Phone   E-mail 

Are you a U.S. citizen?  Yes  No  If not, what is your green card number? 

Are you:  Male  Female 

Do you have a Learning or Physical Disablity? Yes  No
If Yes, Please Describe

What is your cultural background?  American Indian  Asian  Hispanic/Latino  Black/African American  Native Hawaiian  White

With whom do you live?  Both Parents  Mother  Father  Self  Guardian  Stepfather  Stepmother  Other

Has your mother received a 4-year college degree?  Yes  No Don't know

Has your father received a 4-year college degree?  Yes  No  Don't know

What overall grade do you get most often?  A  B  C  D  F

2.  After finishing high school, what do you plan to do?
Four year college
Two year college
Technical/Vocational college
I do not plan to attend college
Reason for not attending college:

Enter the Armed Forces full-time
Enter the Armed Forces and continue my education
I am undecided about my future educational plans.
Other (Please specity)

3.  What would you like to do as a career?

4.  Please list any activities and/or awards or special recognition you have received:  (for example:  sports, student council, leadership, band, or community activities).

5.  Have you been in an Educational Talent Search program before?  Yes  No

6.  Are you in Upward Bound:  Yes  No
If yes, where:

7.  Juniors/Seniors and GED Students Only:
      Please list any colleges, universities, or vocational schools that you would like information from:

 

CERTIFICATION OF INFORMATION

Your signature below will certify as to the truth of the statements made on this form and will also serve as an authorization for the Educational Talent Search program to request and receive information from your school (including, but not limited to, period report cards, free or reduced lunch status, social security number, standardization test results, use of photographs including but not limited to the ETS webpage and ETS Facebook and bebo pages, and transcriptions that might be pertinent to the program). It will also imply your permission for the student to take part in all activities related to Educational Talent Search.

Applicant Name   Date 
Applicant Signature (if submitting hard copy)   Date 
Note: Electronic submission of this application confirms your signature
 

In accordance with Title IX of the Educational Amendments of 1972, Section 504 of the Vocational Rehabilitation Act of 1973, and Title VI and VII of the Civil Rights Acts of 1964, Southwestern Community College does not discriminate on the basis of disability, sex, race, color, religion, or national origin in its educational programs, activities, admission procedures, or employment practices.
 

IF APPLICABLE, PAPER APPLICATIONS MAY BE SENT TO: