California State University-San Bernardino-Colt-TS

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TRiO EDUCATIONAL TALENT
SEARCH
PROGRAM APPLICATION

Educational Talent Search

Congratulations!
You have been nominated to apply for the California State University San Bernardino (CSUSB) Educational Talent Search (ETS) program, a free college preparatiory program aimed to increase the number of students who pursue and complete a college education. The purpose of this project is to encourage low-income and potential first generation college students to complete middle school and high school and go on to complete college. However, only 2/3rds of our total student enrollment must be both low-income and first-generation college-bound students.

Services listed below are free of charge and will be offered at target schools or at CSUSB.
- College Awareness Activities
- Academic, financial, and career guidance, including advice on entry into college
- Career exploration and aptitude assessment
- College Visits
- Assistance in completing college admissions and financial aid applications step-by-step
- Assistance in preparing for college entrance exams
- Special activities for eighth graders
- Workshops for the parents of participants
- Assistance to pay for college entrance exams and admissions application fees
- Access to Academic Tutoring
If you would like for your child to participate in this program, please submit the following forms to ETS:
Program Application with the following sections completed:
- Income Verification - sign certification of income statement (ETS Application - Step 3) OR provide copies of the following documents: (last year's signed 1040; Social Services Income; or FAFSA)
- Student Needs Assessment (last page of application packet)
- School Transcript or most recent progress report (sign Release Statement - ETS Application - Step 4)
Please submit this electronic application completely filled out and signed. An ETS Staff member will be in contact with you with additional information regarding the status of your application.

CSU San Bernardino
Educational Talent Search
5500 University Parkway PL 281
San Bernardino, CA 92407

Once your application has been reviewed you will receive a letter via email indicating your enrollment status. Applicants accepted into ETS are eligible to receive services until they complete their college degree. If you have questions, please feel free to contact us at (909) 537-4380. The school districts served by CSUSB TRiO Educational Talent Search program are:

Colton Joint Unified School District
Rialto Unified School District
San Bernardino City Unified School District

Thank you for your interest in the CSUSB Educational Talent Search program.

Sincerely,
Tanika Gardner
Project Director TRiO
Educational Talent Search

100% Federally Funded

CSUSB TRiO Educational Talent Search
5500 University Parkway PL 281 San Bernardino, CA 92407
Phone: 909-537-4380 FAX: 909-537-7507
www.csusb.edu/educational-talent-search
(Revised 8/12/19)

Funded by the U.S. Department of
Education TRiO Programs

STEP 2: Parent/Guardian Information
All fields are required, please write N/A in the space if it does not apply.
Mother/Guardian Name*

First NameLast Name
Phone*
(999)999-9999
Email*
example@example.com
Is Mother/Guardian employed?*

YesNo
Occupation*
Father/Guardian Name*

First NameLast Name
Phone*
(999)999-9999
Email*
example@example.com
Is Father/Guardian employed?*

YesNo
Occupation*
a) Please indicate the highest grade completed: Mother*
a) Please indicate the highest grade completed: Father*
a) Please indicate the highest grade completed: Guardian*
b) Please list mother/guardian degree or input N/A if it does not apply*
b) Please list father/guardian degreee or input N/A if it does not apply*

Questions continued*

	Yes	No
c) Is the student in foster care or a ward of the court?
d) Is student an emancipated minor or does he/she have a court-appointed legal guardian?
e) Is student less than 18 years of age and an orphan with no legal guardian?
f) Is student married?
g) Does student have children or other dependents who receive more than half their support from him/her?
h) Has a school representative or other agency determined student to be an unaccompanied youth who is homeless?

STEP 3: Income Verification
All fields are required, please write N/A in the space if it does not apply.
Parent should answer the following questions if all answers in STEP 2 (c-h) are NO.
Student should answer the following questions if they answered YES to any question in STEP 2
Family Size: Total number of people currently living in the household and supported by parent or guardian, including children under 24 who are away and attending college.*
Please select the following that applies to you and fill out the corresponding information below.*

My family’s exact taxable income (amount after all deductions not gross) from last filing year (specify below) (federal Income tax return - IRSForm 1040, line 10 (1040A and 1040EZ no longer used by IRS)My family had no taxable income during the last filing year, or was not required to file taxes but earned an annual income of $(specify below) from the following source or other sources (specify below)
My family's exact taxable income amount*
My family's annual income, if none was taxable*
Source of annual income*
Other Sources of Income*

General Assistance (G.A.)Social Security (SSI)CalWORKs (Welfare)Subsidized HousingMedi-CalFood StampsUnemployment
In accordance with the TRiO/ETS eligibility requirements set forth by the United States Department of Education, I hereby certify attest under penalty of perjury that above statement of family income for the year specified is true and correct.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

STEP 4: Parent/Guardian Acknowledgement of Participation
All fields are required, please write N/A in the space if it does not apply.
RELEASE STATEMENT & AGREEMENT

Please read carefully then sign and date where indicated. By signing this application, I certify that all information provided above is true and accurate to the best of my knowledge. I understand that all information on this application, as well as that released from the school, will be held in strict confidence by the TRiO Talent Search program staff. I authorize the release of academic records such as (National Student Clearinghouse, copy of my child’s school transcript, high school and college student ID numbers, test scores, ACT/SAT or GED scores) to the CSUSB TRiO Talent Search program to assess my student’s need/appropriateness for program services, discern academic progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements during middle and high school and while receiving college follow-up services. I authorize the TRiO Talent Search program to share and discuss information with participant and school personnel in support of the student’s academic success including educational and tracking websites. I give permission for my student to participate in activities and field trips supervised by Talent Search personnel. I also give permission for the Talent Search program to take photographs during activities and trips, and grant permission to use my student’s name, comments, and/or photos/videos for educational and/or promotional purposes. I understand that this authorization will remain in effect while the student is enrolled in the CSUSB TRiO Talent Search program or until I provide written notice to revoke the authorization.
Student's Printed Name*

First NameLast Name
Student's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Printed Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Incomplete or unsigned applications will be returned for completion before being considered for enrollment.

Student Needs Assessment
All fields are required, please write N/A in the space if it does not apply.
Please help us get to know you better by filing this out completely and honestly
Name*

First NameLast Name
School*
Grade*
After I graduate from high school, I plan to*

Attend a 4-year college/universityAttend a community collegeAttend a trade/technical schoolWork full timeJoin the militaryI am not sure of my plans yet

Select activities that you would like to participate in during the 2023/2024 academic year. (Select 4 activities only). Rank your top 4 activities, 1 through 4, with 1 = activity of greatest interest

	Rank
1) College Majors & Admissions Requirements
2) STEAM (Science, Technology, Engineering, Art, Math Activities)
3) ETS LEAD (Leadership, Empowerment, Advocacy, Development Activities)
4) College campus visit/Field trips/Cultural events
5) Career Exploration
6) Clubs and Community Involvement
7) Financial Aid and Scholarships
8) Self-esteem/awareness
9) Academic support

10) List colleges you are interested in.*
11) Why do you want to go to college?*
12) What do you see as the biggest obstacles that may prevent you from going to college?*
13) What do you like most about school? (include academic and social aspects) *
14) Do you have any siblings in the following school districts: CJUSD, RUSD, SBCUSD? If yes, please list their name, grade, and school.*
14) Please list your social media username(s).*
15) How much effort do you put into your studies?*

A lotSomeNot muchNone
16) Do you have a computer with internet access at home?*

YesNo
17) What career major(s) are you interested in?*
I realize that I must meet monthly with my ETS Staff person in order to benefit from program services. Given last year’s academic performance, I plan to set the following two goals to improve academically:
Goal 1*
Goal 2*
Student's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy