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.

Parent/Legal Guardian Name

First NameLast Name
Work Telephone #
(999)999-9999
In case of emergency, please contact

First NameLast Name
Telephone #
(999)999-9999
May we use photographs of the student in publications or publicity?

Mercer County Community College

James Kerney Campus
102 North Broad Street, KC 118
609-570-3184
talent@mccc.edu
1. My strengths and skills
2. My interests and hobbies
3. My career goals
4. Most difficult subject

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)

19. Other / Otro

I give my son/daughter/ward permission to participate in Educational Talent Search (ETS) at Mercer County Community College (MCCC).

I also absolve MCCC, Educational Talent Search, their personnel and the Trenton Public School District of any liabilities and claims arising from my child’s participation, and attendance in the program, including travel to and from events and activities.

Medical release: I consent to and authorize emergency and non-emergency medical care to be provided to my child in the unlikely event of a health problem, emergency or injury occurring during my child’s attendance in Educational Talent Search. I give my consent and authorization to appropriate staff to use their judgment in seeking medical care for my son or daughter. I understand that an attempt will be made to contact me in the event that emergency medical care is needed.

Mandated reporting: I give permission for Educational Talent Search to obtain the academic records/information for the above named student throughout their high school career and for six years following their graduation to allow for annual tracking of ETS participant’s education as is required by US Department of Education regulations to evaluate the program. I understand that this information will be held in compliance with FERPA and other applicable state laws and will only be accessible to appropriate program staff and the US Department of Education personnel.
Parent/Guardian's Signature

Clear
Date Signed

MonthDayYear
mm-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.