Pima Community College-Desert Vista-TS

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Educational Talent Search

New Student Application

5901 South Calle Santa Cruz * Tucson, Arizona 85709‐6070 * Telephone: (520) 206‐5046 * Fax: (520) 206‐5206

Parent/Guardian Application
With whom does the student currently reside?*

Only Mother/GuardianOnly Father/GuardianBoth
Is this

MotherGuardian
Mother/Guardian Name

First NameLast Name
Primary Phone
(999)999-9999
Email
example@example.com
Is this

FatherGuardian
Father/Guardian Name

First NameLast Name
Primary Phone
(999)999-9999
Email
example@example.com
Did either parent/guardian, with whom the student currently resides, graduate from a United States university with a Bachelor’s degree/4‐year degree?*
Number of people living in the household *
Family Income Status – Taxable Annual Income (not Gross Income)*
(Income Tax: Form 1040, line 43; Form 1040A, line 27; Form 1040EZ, line 6)
Is English a Second Language for either parent/guardian?*
Does anyone in the household receive any type of public assistance? (I.e. WIC, AHCCCS, Food Stamps, free/reduced lunch)*

Student Eligibility Criteria
Student Residency Status*

US CitizenPermanent ResidentOther
Student Social Security Number *
999-99-9999
Grade Point Average if you do not know to place NA*
Is English a Second Language for the student?*
Is the student currently enrolled in a college preparation program listed below?*
If yes, please indicate

AVIDTRiO Upward BoundOther
Is the student a foster youth?*
(OR) Is the student Youth On Their Own (YOTO)?*
Is student Independent?*
Does the student have a child/children?
If yes, how many?
Is the student employed?*
If yes, where?
How many hours do you work a week?
Did anyone refer the student to the TRiO ETS Program?*
If yes, who?

Student Initial Needs Assessment
Do you have a desire to go to college, but do not understand the process?*
Will you attend college if you do not receive assistance from the TRiO ETS Program?*
Do you need additional educational resources to be successful in High School?*
Would you like to be exposed to different career options?*

Student & Parent/Guardian Authorization
The TRiO Educational Talent Search Program is funded by the U.S. Department of Education. The program is designed to encourage and prepare participants to attend a post‐secondary education. All information is strictly confidential and is used solely for the purpose of determining eligibility of students applying for participation in the Educational Talent Search Program. All applications are accepted for review regardless of race, color, national origin, religion, gender or disability (U.S. Dept. of Education‐GEPA Section 427). Parent/Guardian signatures are required in order to process the application

Permission and Release Authorization

I, parent/guardian of student, hereby authorize the TRiO Educational Talent Search (ETS) program to contact and request educational information from, as well as share information with my student’s school, teachers, and counselors, including, but not limited to class schedules, grades, test scores, grade point average, transcripts, attendance, and progression reports as required. I give my student permission to participate in TRiO ETS activities, both on and off the school location, to include traveling in Pima Community College vans and/or Sunnyside Unified School District and/or Tucson Unified School District transportation vehicles. I also give my student permission to be interviewed and/or photographed by digital, still photo film, or video recorder by TRiO ETS Program for use on radio, TV, printed and social media, or in project documentation and promotional materials. Our signatures below indicate our commitment to the TRiO ETS program.

We, student and parent/guardian, understand TRiO ETS is a federal program authorized by the U.S. Department of Education. We also understand that the information provided will be used to document student eligibility for the program. We certify that all of the information on the New Student Application and all sections provided are accurate and true.
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
As an active participant in the program, you will be expected to adhere to the following:
- Student must attend school regularly and on time.
- Student must achieve and maintain a 2.5 GPA (C+ average) or better to remain eligible for the Educational Talent Search Program.
- Student must request tutoring assistance, if needed, and schedule tutoring sessions.
- Student must attend required tutoring sessions when referred by Program Coordinator.
- Student must actively participate in at least two workshops and/or fieldtrips per school year.
- Student must meet with Program Coordinator for small group or individual sessions at least 2 times per school year.
- Student must evaluate, set, and accomplish personal and educational
  goals.
- Student must stay on track to successfully graduate from high school.
- Student will enroll in a College or University after graduating from high school.
- Parent/Guardian and/or Student must notify Program Coordinator of any changes in contact information, such as, address, cell number, etc.
- Parent/Guardian and/or Student must notify Program Coordinator of any changes in school, class schedule, disciplinary action, and/or personal or academic problems.
- Parent/Guardian will attend parent meetings or participate in Educational Talent Search parent events, when applicable.
- Parent/Guardian is encouraged to support all Educational Talent Search workshops, events, and fieldtrips offered to their student.
We, student and parent/guardian, understand and agree to accept the expectations outlined above. We understand that failure to adhere to the above conditions may result in elimination from the TRiO Educational Talent Search Program
Student Name*

First NameLast Name
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
If you have questions or concerns, please contact the TRiO Educational Talent Search program office at (520)206-5046.