Statement of Confidentiality: The information required by this application is for the purpose of determining the applicant’s eligibility for the MCC-Educational Talent Search Program.  Information received is treated confidentially. *Please complete all items.

If not a U.S. Citizen, please write down your Permanent Resident I.D. # and attach/upload a copy of your Permanent Resident I.D. card to this application. If you don’t have a Permanent Resident card, a valid I-94 card issued to you by the U.S. Department of Immigration might be acceptable.  No application will be accepted without proper documentation.

In order to be considered for admission to our program, please answer ALL of the questions below as honestly as possible, sign and date.

To be completed by the parent or legal guardian.

The TRiO Talent Search Program is a federally funded program that requires participants meet certain guidelines to participate. The information provided on this form will be used to determine if the student is eligible to apply. It does not imply any automatic acceptance into the program.

(Taxable Income = adjusted gross income minus any deductions, exemptions or other adjustments you are entitled to when filling out your taxes.  You can find this amount in last year’s tax return under the “Taxable Income” line, usually on second page of Income Tax Return form.

Please check below if either of the applicant's parents graduated from an accredited 4-year university or college in the U.S.

*Please read carefully before signing. By signing below, I authorize and certify the following:

1.) I hereby authorize Middlesex Community College TRiO-Educational Talent Search Program to obtain copies of any of my child’s academic and/or financial assistance records from educational institutions is attending now and from educational institutions attending in the future, including information related to the free/reduced school lunch in the Lowell Public Schools.
2.) I also authorize the Middlesex Community College TRiO-Educational Talent Search Program to use my child’s picture in program publication materials (brochures, newspapers, websites, and displays).
3.) Should my child require medical attention while participating in any program activities and I cannot be contacted, I give my consent to medical examination and treatment deemed necessary by an attending medical professional.

4.) My signature below certifies my consent to the statements 1-3 above and indicates that, to the best of my knowledge, the information given on this application is true, complete, and accurate.