Parent/Guardian 1 Information

Parent/Guardian 2 Information

Please check any of the areas below that you feel you need or would like help.

I hereby inform the Talent Search program that the taxable income (2022 Form 1040, line 15, 2018 Form 1040 line 10) generated in the participant’s household is $enter in Blank 1 and that there are enter in Blank 2 persons residing in the household.

PARENT/GUARDIAN PERMISSION
I give permission for my child/student to attend the Virginia Tech Talent Search (TS) program and all the required activities including field trips.

RECORDS RELEASE
I understand that my initials on this application permits Virginia Tech and Virginia Tech TRIO Programs to collect and use all academic and extracurricular activity information on my child during high school and college. This information gathered includes but it is not limited to academic progress reports, academic transcripts, standardized testing by school, local, state or federal programs and other performance reports. All of the information gathered will be kept secure and be confidential. Also, the gathered information will be utilized to develop better services for the benefit of each participant and their specific needs.

MEDICAL AND LIABILITY RELEASE
I authorize the TRIO Programs staff to act on my behalf in case of an emergency, accident or illness. I release Virginia Tech, and the Virginia Tech TRIO Programs staff from any liability or claims that might occur due to the participation of my child in the program.

PHOTO AND VIDEO RELEASE
For valuable consideration received, the undersigned hereby irrevocably consents to and authorizes the use by Virginia Polytechnic Institute and State University ("Virginia Tech") of the undersigned's name, image, voice and/or likeness as follows: Virginia Tech shall have the right to publish, re-publish, adapt, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or re-use the undersigned's name, image, voice and/or likeness in connection with any product or service in all markets, media or technology now known or hereafter developed in perpetuity throughout the universe including advertising, promoting and merchandising the product or service. Virginia Tech may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties, commercial or nonprofit.

In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552A), you are notified the Department of Education is authorized to collect information, including Social Security numbers (SSNs), to implement the TRIO Programs under Title IV of the Higher Education Act of 1965, as amended (Pub. Law 102- 325, sec. 402A and 402C). In accordance with this authority, the Department receives & maintains personal information on participants in the TRIO Programs The principal purpose for collecting this information is to administer TRIO Programs, including tracking & evaluating participants’ academic progress. Your SSN is collected only to serve as the unique identifier for matching participant records across years. Providing the information on this form, including a SSN, is voluntary; failure to disclose a SSN will not result in denial of any right, benefit, or privilege to which the participant is entitled. The information that is collected on this form will be retained in the program files & may be released to other Department officials in the performance of official duties. The information will not be disclosed outside of the Department, except as allowed by the Privacy Act of 1974, pursuant to the routine uses identified in the System of Records Notice titled “TRIO Programs Annual Performance Report (APR) System (TRIO APR).” I specifically grant permission to Virginia Tech TRIO Programs to obtain information from the school system regarding my child’s academic and disciplinary record. TRIO Programs Staff may obtain any and all information and documentation necessary for processing my/my child’s application and for meeting federal performance and tracking reporting requirements, including but not limited to transcripts, grade reports, and test scores. I certify that any information which I have provided herein is true and correct to the best of my knowledge.

Virginia Tech does not discriminate against employees, students, or applicants on the basis of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, or veteran status; or otherwise discriminate against employees or  applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees, or applicants; or any other basis protected by law. For inquiries regarding non-discrimination policies, contact the Office for Equity and Accessibility at 540-231-2010 or Virginia Tech, North End Center, Suite 2300 (0318), 300 Turner St. NW, Blacksburg, VA 24061.