Educational Talent Search @ MCCC

EDUCATIONAL TALENT SEARCH APPLICATION
James Kerney Campus, KC 118 • (609) 570-3184
www.mccc.edu/talentsearch • talent@mccc.edu
Si desea ver el formulario en español, cambie el idioma en la esquina superior derecha.

Please list the name(s) of adult(s) the student lives MOST of the time and select the correlating relationship

Name of Adult #1

First NameLast Name
Cell Phone
(999)999-9999
Work Phone
(999)999-9999
Email
example@example.com
Contact Preference
Name of Adult #2

First NameLast Name
Cell Phone
(999)999-9999
Work Phone
(999)999-9999
Email
example@example.com
Contact Preference
If student is currently in FOSTER CARE please provide the name and contact information for the students FOSTER CARE SOCIAL WORKER
Name:

First NameLast Name
Work Phone:
(999)999-9999
Email:
example@example.com
In case of emergency, please contact

First NameLast Name
May we use photographs of the student in publications or publicity?

The U.S. Department of Education funds Talent Search Programs to serve a percentage of students who meet the eligibility criteria of low-income, first-generation potential college students (meaning neither parent has a four-year college degree "Bachelor's Degree"). In fulfilling this federal regulation, we ask that you provide the following information used to determine eligibility. The information you provide is confidential and used solely to determine program eligibility.
Number of people living in household
What was your household's TAXABLE INCOME last year? (NOTE: Do not use gross or net income, but your TAXABLE INCOME found on Line 15 of the IRS 1040 form. )
What is the HIGHEST level of education obtained by either BIOLOGICAL or ADOPTED PARENT, who the student lives with.

Other
Approximate taxable family income
Check one
Did either parent complete a 4-year college education?
Source of family income

Other
Parent/Legal Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy

Indicate below on a scale of 1 to 5 (1 least and 5 greatest). Classifca tus necesidades marcando del uno (Menor) al 5 (Major).

Rows	1 to 5
1. Need academic advisement / Necesito orientación academica
2. Need high school diploma or GED / Necesito diploma de cuarto ano o el GED
3. Need information about college selection / Necesito información sobre la seleccion de universidades
4. Need to apply for financial aid / Necesito solicitar asistencia económica
5. Need graduation information / Necesito información de graduación
6. Need assistance with personal problems / Necesito información de orientacion personal
7. Need more self confidence / Necesito más auto-confianza
8. Need better self motivation / Necesito mejorar mi auto-motivación
9. Need more friends / Necesito más amigos
10. Need better skills in managing personal time / Necesito mejorar las técnicas de como manejar mi tiempo personal
11. Need transportation / Necesito transportacion
12. Need information concerning career options / Necesito orientacion sobre las vocaciones
13. Need job seeking skills / Necesito aprender las técnicas de como obtener un trabajo
14. Need better general study techniques / Necesito mejorar las técnicas de estudio
15. Need better test taking techniques / Necesito mejorar las técnicas de tomar examenes
16. Need better note taking techniques / Necesito mejorar las técnicas de tomar notas
18. Need tutoring / Necesito tutoria en
19. Other: / Otro (specify below)

Records will be used to assess student needs, monitor progress, document eligibility, and for reporting purposes. This information is confidential and protected under the General Education Provision Act. Confidential information will not be released without your written consent: I hereby grant permission for the Educational Talent Search/VIP programs at Mercer County Community College to have access to educational records including (but not limited to) grades, test scores, class schedules, postsecondary enrollment, discipline records and attendance for the duration of the student's enrollment in Educational Talent Search. This also authorizes the postsecondary institutions to release to the MCCC Educational Talent Search program copies of college academic enrollment and student aid award information.
I authorize the use of my child's photo for publicity and recruitment purposes (brochures, social media spotlights, etc.)
I, the undersigned, confirm that all the information on this application is true to the best of my knowledge and feel that my child has shown potential for success in a postsecondary education program. (Signature required below):
Parent/Guardian's Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
Consents/releases remain in effect until written revocation is received by Educational Talent Search at Mercer County Community College, James Kerney Campus, 102 North Broad Street, Trenton NJ, 08608.