University of Georgia-TS-High School Application Form

Educational Talent Search

High School Application
- Name*
  
  First NameMiddle NameLast Name
- School*
  
  Clarke CentralWarren County HighCedar ShoalsElbert County HighHancock County HighWilkes County High
- Date of Birth*
  
  MonthDayYear
  mm-dd-yyyy
- Age
- Gender*
  
  MaleFemale
- Ethnic Origin*
  
  African American/BlackAmerican Indian/Alaska NativeAsian/Pacific IslanderEuropean American/WhiteHispanicMore than one ethnic origin
- U.S. Citizen*
  
  YesNo
- Visa Type/Number
- Free/Reduced lunch participant?*
  
  YesNo
- Grade Point Average (GPA)
- Are you on social media?
  
  FacebookInstagramTwitterOther
- If so, how can we find you?
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- School Email Address*
  example@example.com
- Student Cell*
- Parent Cell
- Emergency Contact Person
- Relationship to you
- Emergency Telephone
- Student Signature
  
  Clear
- 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
- Parent(s)/Guardian(s) Name(s)*
  
  First NameLast Name
- Parent(s)/Guardian(s) Name(s)*
  
  First NameLast Name
- Email Address*
  example@example.com
- Student lives with: (check one)*
  
  Both ParentsOne ParentParent/Step ParentFoster ParentLegal GuardianSpouseOther
- Number of family members in home? *
  (Brothers, Sisters, Parent(s), etc.)
- Select your family’s yearly gross income*
  
  $0-12,525$12,526 – 16,875$16,876 - $21,225$21,226 - $25,575$25,576 - $29,925$29,926 - $34,275$34,276 - $38, 625$38,626 - $42,975$42,976+
- Income Breakdown (If none, just enter 0)
- Social Security Income*
- AFDC or ADC *
- Child Support*
- Other Untaxed Income*
- Did either Parent GRADUATE from a four year college? *
  
  YesNo
- Name of College*
- 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.
- Parent/Guardian Signature*
  
  Clear
- 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, {parentName95} 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.
- Parent Name*
  
  First NameLast Name
- Student Name*
  
  First NameLast Name
- Permission to Photograph/Video Student: I agree to allow ETS and its constituents to photograph or digitally record my child for use in publication.*
  
  YesNo
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- Parent/Guardian Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- University of Georgia
  
  High School Contract
  
  As a student in the University of Georgia’s Educational Talent Search Project and as a major objective of ETS is to assist me with successful completion of secondary school and postsecondary planning/placement, I agree to:
  1. Follow my Individual Development (IDP)
  2. Give my ETS Program Specialist all mid-term/nine weeks report cards and transcripts.
  3. Discuss my changes in my academic plan with my parent (s) and ETS Program Coordinator.
  4. Participate in career/educational activities, tours and workshops.
  5. Discuss my career aspirations and postsecondary plans with my parent(s).
  6. Register and take the ACT/SAT as recommended by my Program Specialist.
  7. Research at least three (3) postsecondary institutions by completion of the eleventh (11th) grade.
  8. As the parent(s) of an ETS student, I agree to participate in and support ETS and parents activities including chaperoning field trips, parent orientations as well as Parent Advisory Board meet
  NOTE: If a student is to fully gain from the services offered by ETS, it is imperative that he/she attends counseling and academic sessions, school workshops, in addition to cultural /educational tours. All services offered by ETS are contingent upon one another. Failure to fulfill contract agreement could result in termination from ETS.
- *Student Initial Here to Acknowledge Reading of Contract
- *Parent/Guardian Initial Here to Acknowledge Reading of Contract
- 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.
- Parent Name
  
  First NameLast Name
- Email
  example@example.com
- Phone
- Preferred method of contact (please select):
  
  PhoneEmail
- Are you interested in leadership role in Association (please select):
  
  YesNoMaybe
- 1) Do you have any special needs?*
  
  YesNo
- List:*
- 2) Have you or are you repeating a grade?*
  
  YesNo
- 3) Have you ever considered dropping out of school?*
  
  YesNo
- 4) Do you need enrichment/tutoring in any subject?*
  
  YesNo
- List*
- 5) Do you need to develop/improve your study skills?*
  
  YesNo
- 6) How many years of postsecondary education do you plan to complete?*
  
  1-2 Years: Associate Degree/Technical School3-5 Years Bachelors DegreeMasters or Doctorate DegreeUncertain at this timeWill not Attend
- 7) Are you knowledgeable of the classes that should be taken to prepare for college?*
  
  YesNo
- 8) Are you currently enrolled in college preparatory classes?*
  
  YesNo
- 9) Do you know the procedure (s) for admission to a postsecondary institution?*
  
  YesNo
- 10) Have you contacted any college(s) for admission information?*
  
  YesNo
- List: *
- 11) Have you begun academic preparation for the PSAT, ACT or SAT?*
  
  YesNo
- 12) Will you need a college application, ACT or SAT fee waiver?*
  
  YesNo
- 13) Are you aware of financial aid programs that will assist in paying college tuition fees?*
  
  YesNo
- 14) Will you need assistance applying for financial aid or scholarships?*
  
  YesNo
- 15) What is your current career interest? *
- 16) Do you know the college major that will prepare you for this career?*
  
  YesNo
- 17) Do you participate in extracurricular school activities?*
  
  YesNo
- 18) Are you or any member of your family participating in ETS or Upward Bound?*
  
  YesNo
- 19) If so which: Program and Name:*
- 20) During the academic year, how can ETS assist you in becoming a better student?*

Educational Talent Search