Clatsop Community College-TS

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Talent Search Program Application

Thank you for your interest in Talent Search (TS). We will notify you by mail if the student is enrolled. TS is a federally funded program for qualified students in grades 6-12. TS services help students explore college and career opportunities and enter the college or other training of their choice after high school. As a Talent Search student, you will participate in workshops, educational guidance, field trips and other activities to help you be a successful high school and college student. The Clatsop Community College Talent Search program is 100% funded by a U.S. Department of Education grant in the amount of $387,128.

Family Information
All fields marked with * are required and must be filled.

We are required to obtain this information to process your application. All information is strictly confidential and is used only to determine eligibility for Talent Search services.

First-Generation: a student is considered First-Generation if the natural or adoptive parent(s) who the student live with has a 4-year Bachelor degree from a university. Please note - if the parent does not live with the student, we do not have to consider their education and you do not have to list them. We do not have to count 2-year Associates degrees.
Student lives with (please check all that apply)

Both parentsMotherFatherStepparentGrandparent(s)Legal guardianFoster parent(s)Other
Please complete the following information about each parent/guardian who currently lives with this student
Mother/Guardian's Name*

First NameLast Name
Does the Mother or Adoptive Parent who lives with the student have a 4-year Bachelor degree from a university?*

YesNoDoes not live with student
Check if same address as student

Check here
If not, please write your address
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email address
example@example.com
Employer
Work Phone
(999)999-9999
Cell Phone
(999)999-9999
Emergency Phone
(999)999-9999
Father/Guardian's Name

First NameLast Name
Does the Father or Adoptive Parent who lives with the student have a 4-year Bachelor degree from a university?*

YesNoDoes not live with student
Check if same address as student

Check here
If not, please write your address
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email address
example@example.com
Employer
Work Phone
(999)999-9999
Cell Phone
(999)999-9999
Emergency Phone
(999)999-9999
(Optional) Notes – if you want to provide us with any other information regarding the student’s First- Generation status please add it here.
Relationship to student *
Relationship to student

Please list the names of the student’s brothers and sisters who live with you and are in school

	Name	School	Grade
1
2
3
4
5
6
7
8
9
10

(Optional) Notes – if you want to provide us with any other information on siblings or household members.

Authorization & Medical Release
The U.S. Department of Education (USDE) requires all Talent Search programs to track students’ progress through postsecondary education and to report this information to USDE. Talent Search’s continued funding depends on reporting this information about TS students. We report to USDE only the student information that USDE requires.
All fields marked with * are required and must be filled.

1. All information in this application is true and accurate to the best of my knowledge.

2. I give my permission for my son/daughter to participate in all Talent Search activities. (You will be notified of any travel activities and asked to give permission specifically for trips.)

3. I authorize Clatsop CC Talent Search to obtain student records and documents as necessary, including grade reports, transcripts, test scores, financial aid awards, and college admission and enrollment verification. This information will be held in strict confidence and will be used for TS purposes only.

4. I authorize Talent Search to release or obtain information from any agency or program providing supplemental services to my student.

5. I give my permission for my student’s name, photograph, work and/or statements to be used by Talent Search for promotional, publicity, or instructional purposes.

6. I understand that, to stay enrolled in Talent Search, my student is expected to be a good school citizen and to make good academic effort.

7. I consent to my child using the Internet and other technology and accept responsibility for appropriate use thereof.

8. I understand that completion of this form does not guarantee acceptance into Talent Search.

9. I grant permission to the Talent Search program and Clatsop Community College and its authorized representatives to furnish first aid to my son/daughter as needed, and to seek medical attention through the nearest medical facilities when students are on field trips and other authorized activities. This permission is conditioned on the understanding that in the event of serious illness or injury or the need for hospitalization and/or major surgery, TS staff will make all reasonable efforts to contact me. Failure in such efforts should not prevent TS from providing emergency treatment as may be necessary for the best interest of my child.
Parent Signature*

Clear
To sign, please click and hold using your mouse or use your finger
Date*

MonthDayYear
mm-dd-yyyy
Student Signature*

Clear
To sign, please click and hold using your mouse or use your finger
Date*

MonthDayYear
mm-dd-yyyy