You Must Complete All Information Below to Have Your Application Processed
This information is strictly confidential and only for office use and funding purposes only

Income Breakdown (If none, just enter 0)

I affirm that the information provided is complete and correct. Any deliberate falsification or omission of data supplied may result in denial of placement or dismissal from the Educational Talent Search Program.

Authorization
for
Release of Student’s Records, Information and
Permission to Photograph/Video Student

Privacy Act
In accordance with the Family Educational Rights and Privacy Act, I understand that all information concerning my child and me is confidential and will not be revealed to anyone except Educational Talent Search Program Personnel.

I, , Parent/Legal Guardian of ,(Please Print) (Please Print) authorize the Superintendent of Schools or her/his Designee(s) to release all records listed below to the following Agency and its Designee(s):
Records:
Attendance Data
Psychological Education Reports Testing Data
Health Records
Grade Transcripts/Progress Reports Special Education Placement Data Student Clearinghouse
Social Security Numbers

University of Georgia TRIO Educational Talent Search 243 Milledge Hall Athens, Georgia 30602-1550
(706) 542-7640 (Telephone)
(706) 583-8246 (Fax)

Student Schedules
I further authorize the release of all information regarding my child’s educational, physical and social adjustments in school, as long as s/he participates in the Educational Talent Search Program.

I also understand that prior to transfer, I may review and have all/any part of these records properly interpreted by making such request of the Principal or appropriate Board of Education Personnel.

University of Georgia

Middle School Contract

As a student in University of Georgia’s Educational Talent Search (ETS) and as a major objective of ETS is to assist me with successful completion of middle and high school preparation, as recommended by my Program Coordinator, I agree to:

1. Attend all scheduled ETS Sessions
2. Follow my Participant Educational Plan (PEP).
3. Give my Educational Program Coordinator all my Academic Status
4. Reports and Report Cards.
5. Participate fully in tutoring sessions designed to assist me in successfully completing middle school.
6. Participate in career, cultural/educational activities, tours and workshops as offered.
7. Encourage my parent(s) to attend, participate in and support ETS Parents’ activities as offered.
8. Inform my Program Coordinator of my upcoming school placement at the end of each academic year.
   As parent(s) of an ETS student I/we agree to:

1. Attend, participate in and support Parents’ activities designed to assist my/our child with successful completion of middle and high school preparation.

Note: If a student is to fully gain from the services offered by ETS, it is imperative that s/he attends advisement and academic sessions, such as tutoring and school workshops in addition to cultural activities. All services offered by ETS are contingent upon one another. Failure to fulfill contract agreement could result in termination from ETS.

University of Georgia Educational Talent Search Parent Association

Parent/Guardian participation is critical to student success. As a member of our Parent Association, your assistance will help strengthen our program. If you are interested in serving please complete the following.