Texas Southern University-TS

Texas Southern University-TS

Confidential Application & Contact Form
Texas Southern University TRIO Talent Search is a program at Texas Southern University that provides FREE post-secondary planning information and assistance to eligible participants.
Name*

First NameMILast Name
Age
Address

Street Address

Street Address Line 2

CityState

Zip
Phone Home #
(999)999-9999
Cell #
(999)999-9999
Email*
example@example.com
SSN
999-99-9999
Family Size/Household
Date of Birth

MonthDayYear
mm-dd-yyyy
Do you live with both parents?

YesNo
Gender

FemaleMale
Citizenship

USPermanent Resident
A-Registration Number
Upload a copy of your A-Registration Card:

Browse Files

Cancelof
Parent’s Educational Attainment:

Bachelor’s Degree:
Mother

YesNo
Father

YesNo
Ethnicity

Black/African AmericanWhiteNative AmericanAsianHispanicOther

Parent Income Verification
If you filed a Tax Return, please complete Numbers 1 and 2; otherwise, please only complete Number 3.
1. Understanding that a member of my household is a person that in terms of living-expenses, I supported more than 50% in the last calendar year ending December 31.

I,________________(Parent) verify that there was/were ____________ person/people living in my household and, my total income was $_______________.
Blank 1 (Parent)

First NameLast Name
Blank 2 (Number of people in household)
Blank 3 (Total income)
Did you file a Tax Return?

YesNo
2. Taxable Yearly Income: Please complete using most recent IRS Form 1040
Line 11B on 1040
3. Non-taxable Income Sources

TANFSoc. SecDisabilitySNAPUnemployment
Annual Amount $
I, ____________________________________, (please print) certify that the above information is correct and complete to the best of my knowledge.
Blank (Name)

First NameLast Name
Parent's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

Authorization and Information Release Form
To whom it may concern:

I, ________________________,(Student Name) _____________(Student ID#)

hereby give my permission for TRIO Talent Search and/or its representative to discuss, request, and/or receive information from my student academic, financial aid, and/or financial record on my behalf as a part of the educational advisement and assistance services I am receiving through its program.
(Student Name)

First NameLast Name
(Student ID#)*
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature *

Clear
Date*

MonthDayYear
mm-dd-yyyy

Media Release Statement
I, as the parent or guardian of ____________________ hereby give TRiO Talent Search and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media.
Blank (Student Name)
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy