Educational Talent Search
Middle School Reactivation Form
Student Information
Name
*
First Name
Middle Name
Last Name
Today's Date
-
Month
-
Day
Year
mm-dd-yyyy
Social Security Number
Date of Birth
*
-
Month
-
Day
Year
mm-dd-yyyy
School
WR Coile Middle
Clarke Central
Warren Cty Middle
Warren Cty High
Clarke Middle
Hilsman Middle
Cedar Shoals
Elbert Cty Middle
Elbert Cty High
Hancock Cty Middle
Hancock Cty High
Wilkes Cty High
Wilkes Cty Middle
Age
Grade
*
School Email Address
*
example@example.com
Parent's Email Address
example@example.com
Guradian(s)/Paren(s) Full Name
First Name
Last Name
Home Mailing Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Telephone #
Your Cell #
*
Parent Cell #
Emergency Contact Person
Relationship to you
Emergency Telephone
Are you on social media?
Facebook
Instagram
Twitter
Other
If so, how can we find you?
Needs Assessment
1) Are you currently participating in any of the following? (Please check one)
Educational Talent Search (ETS)
Upward Bound
2) Do you have any special needs?
Yes
No
List:
3) Have you or are you repeating a grade?
Yes
No
4) Do you take responsibility for your actions? (School work, chores, money, etc.
Yes
No
5) Do you need to develop/improve your study skills?
Yes
No
6) In which subject(s) do you need tutoring?
7) Do you use time wisely?
Yes
No
8) Are you dependable?
Yes
No
9) Do you know how to handle conflicts without fighting?
Yes
No
Needs improvement
10) Have you ever received in/out of school suspension?
Yes
No
10) If yes, please explain
11) Do you want to attend college or technical school?
Yes
No
12) Are you knowledgeable of the academic classes that should be studied in High school to prepare for college? (8th graders only)
Yes
No
N/A
13) List the career you currently wish to pursue
14) Do you know facts about this career?
Yes
No
15) Are you currently in foster care or ever been homeless?
Yes
No
16) List the school organization(s) in which you are a member/an officer.
(Band, chorus, FBLA,etc.)
17) How do you view the way you act, feel and think?
Negative
Positive
Positive but needs improvement
18) How can ETS assist you in becoming a better student?
Back
Next
Save
Please verify that you are human
*
Save
Submit
Should be Empty: