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
- School of Interest
  
  Four-Year CollegeTwo-Year CollegeVocational/Tech SchoolUndecidedOther
- Name of College(s) you would like to attend
- Career Goals
- Current School You Are In
  
  High SchoolMiddle School
- Current Grade Level
  
  8th9th10th11th12th
- Current School Name
- Other Current School Name
- Are you enrolled in
  
  APDual Credit
- Year of High School Graduation
- Upload copy of Report Card/Transcript:
  
  Browse Files
  
  Cancelof
- Are you currently participating in Upward Bound, GEAR UP, or Educational Opportunity Center
  
  YesNo
- Are you Homeless, or in Foster Care?
  
  YesNo
- Limited English Proficiency
  
  YesNo
- You need assistance in
  
  AdmissionsAcademic Support/TutoringCareer CounselingFinancial AidTSI Test PreparationFinancial LiteracySAT/ACT Test RegistrationUniversity HousingCollege Orientation ActivitiesScholarshipsCost of CollegeOther
- Student's Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- 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
- 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
- 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