George C. Wallace Community College-Hance-TS

  • PARTICIPANT APPLICATION

    Please type or print in blue or black ink. (Please do NOT use white-out!)

    • STEP 1: 

    • Student, please answer the following questions about yourself.

    • Whose phone number?
    • STEP 2:  

    • Student, please answer the following questions about yourself.

    • a. What is the name of your school?*
    • d. What is your birthdate?*
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    • e. Are you Hispanic or Latino?*
    • f. What is your race? (Please check all boxes that describe you.)*
    • g. What is your gender?*
    • STEP 3:  

    • Student, please answer the following question about yourself.

    • a. Are you a U.S. citizen?*
    • STEP 4: 

    • Student, please answer the following questions about your parents and about yourself.

    • a. Has your mother received/earned a baccalaureate degree?*
    • b. Has your father received/earned a baccalaureate degree?*
    • c. Which parent do you regularly live with and receive support from? (Please check only one box.)*

    • Talent Search is funded by the Dept. of Education TRIO programs P044A210756. No student shall be discriminated against on the basis of any impermissible criterion or characteristic including, but not limited to, race, color, national origin, religion, marital status, disability, gender, age or any other protected class as defined by federal or state law. Institutions must publish their policies regarding nondiscrimination.

    • STEP 5:  

    • Student, please answer the following questions about yourself.

    • a. Are you married?*
    • b. Do you have children or other dependents (other than a spouse) who receive more than half of their support from you?*
    • c. Are you an orphan, in foster care, or a ward of the court?*
    • d. Are you an emancipated minor or do you have a court-appointed legal guardian?*
    • e. Are you less than 18 years of age and have no parent or guardian?*
    • f. Are you homeless (i.e., you lack a fixed, regular, & adequate nighttime residence) or are at risk of becoming homeless?*
    • STEP 6: 

    • You (the student) must answer the following questions about yourself if you are at least 24 years old or you answered YES to any question in STEP 5. Your parent(s) must answer the following questions about themselves if you are less than 24 years old and you answered NO to all questions in STEP 5.

    • Size of Family Taxable Income
      1 $23,940
      2 $32,460
      3 $40,980
      4 $49,500
      5 $58,020
      6 $66,540
      7 $75,060
      8 $83,580
    • Does your family's TAXABLE income, NOT TOTAL fall within the following range?*
    • Does anyone in the household receive any of the following?
    • b. What was your family’s taxable (not total) income from the last calendar year? (Please check only one box. Then, provide the requested income information.)*
    • Does anyone in the household receive any of the following?
    • STEP 7: 

    • You (the student) must read the following statement and then sign and date below it. If you (the student) are less than 24 years old and answered NO to all the questions in STEP 5, your parent or legal guardian must also read the following statement and then sign and date below it.

    • By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the student’s official academic records to the Talent Search Dept.of Wallace State Community College understanding that the information in these records will be used only to assess the student’s need for TRIO program services, discern the student’s educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program-reporting requirements. Finally, I authorize Talent Search of WSCC to use the student’s name, statements and likeness, without charge, for promotional purposes in WSCC publications, advertising, video, and other formats.  My child has permission to participate in field trips planned for and supervised by TALENT SEARCH. Further, should my son/daughter require medical attention and/or care while participating in TALENT SEARCH, I give my consent to medical examination and necessary treatment as may seem necessary by the attending physician. This consent shall remain effective so long as my son/daughter is a participant in Talent Search. Should an emergency arise, staff will attempt to provide care as needed.

    • Clear
    • Date*
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    • Clear
    • Date*
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    • Assessment of Student Need for Project Services 

    • Determination & Assessment of Student Need for Project Services

      (34CFR643.32(c)(1-2))

    • What three careers interest you the most?

    • Do you plan to go to college? Note: “College” can mean a community college, university, or trade school.
    • Which services do you need in order to prepare yourself for college? (34CFR643.4) Check the box(es)next to each service you need.
    • Is English your first language?*
    • Do you find it difficult to speak, read, write, or understand English well enough to learn from your teachers at school?
    • Have you taken the ACT?
    • Clear
    • Date*
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    • Submit 
    • Should be Empty: