Midlands Technical College-TS-Application Form

PART II - ETS PARENT APPLICATION

To Be Completed by Parent/Guardian.

ETS is required to verify that our participants meet federal criteria based on educational background and household income level. This information is required of all applicants and may need to be verified in order for students to qualify for participation. ETS and Midlands Technical College ensure that all information provided will be held in confidence in accordance with the Family Educational Rights and Privacy Act (FERPA).

Parent's/Guardian's Name*

First NameLast Name

Relationship to the Student*

Parent's/Guardian's Phone Number*

(999)999-9999

Parent's/Guardian's Address*

Street Address

Street Address Line 2

CityState

Zip

Parent's/Guardian's Email Address*

example@example.com

Educational and Household Income Information (Please note the following information is mandatory):

1. Did the student’s MOTHER graduate from college with a four-year degree?*

YesNoUnknown

College/University Name*

2. Did the student’s FATHER graduate from college with a four-year degree?*

YesNoUnknown

College/University Name*

3. Does the student receive free lunch?*

YesNo

4. Annual Taxable Income (This can be found on the 1040 Line – 15)*

5. Number of people living in your household?*

6. Please indicate tax return filing status*

SingleHead of HouseholdMarriedDid Not File

7. Indicate the total yearly amount your household receives from each of the following:

TANF*

Disability*

Other*

Certification and Signatures

I/We certify that all the information provided including my taxable income and tax filing status are correct and true to the best of my knowledge.
I/We authorize the release of my school and/or financial records to the ETS program, including test scores and any other academic information and test results necessary to complete the program’s application process.
I/We understand that completion of this application does not guarantee acceptance into the ETS program.
I/We understand that the information provided on this application will be held in confidence by the ETS staff.
I/We consent to the student using Internet and other technology and accept responsibility for any inappropriate use.
I/We understand that if I need accommodation for a disability to participate in ETS, or in any of its scheduled activities, I must contact the Director of Educational Talent Search at (803) 822-3628 at least 30 working days prior to the activity.

Student's Signature*

Date Signed*

mm-dd-yyyy

Parent's/Guardian's Signature*

Date Signed*

mm-dd-yyyy

Please note that all applications are accepted for review regardless of race, color, national origin, religion, gender or disability (U.S. Dept. of Education - GEPA Section 427). Educational Talent Search is a U.S. Department of Education TRIO Program, grant-funded to Midlands Technical College. Award #P044A110009

Midlands Technical College

Educational Talent Search

FERPA Permission for Release of Information

Educational Talent Search Student’s Verification of Contact Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone*

(999)999-9999

Cell Phone*

(999)999-9999

Student's Email*

example@example.com

The Educational Talent Search Program is funded by the U.S. Department of Education and is sponsored locally by Midlands Technical College. The grant requires verification of each participant’s secondary and post-secondary college enrollment, progress and graduation.

I give permission for the release of my student records and documents as needed. Such records may include: test scores, report cards, class schedules, transcripts, college admission information, financial aid information, enrollment and graduation verification. This information may be obtained through the guidance office, college or national student clearinghouse.

I authorize the Educational Talent Search program to obtain the necessary information needed for the grant program. I understand that all of my records will be kept in confidence and in accordance with the Family Educational Rights and Privacy Act (FERPA) of 1974.

Student's Name*

First NameLast Name

Student's Signature*

Date Signed*

mm-dd-yyyy

Parent's/Guardian's Name*

First NameLast Name

Parent's/Guardian's Signature*

Date Signed*

mm-dd-yyyy