If yes, list TAXABLE INCOME, NOT GROSS INCOME

All information will be kept strictly confidential.

With my signature, I hereby grant permission to the staff of the Atlanta Metropolitan State College         Talent Search Program to access my child’s school records, including the following:

• Grades, transcripts, test scores, and free or reduced lunch eligibility

I  hereby authorize post-secondary institutions to release to Talent Search copies of

• College academic, enrollment, and student aid award information from the college/university that I will be attending after high school graduation

Records will be used to assess student needs, monitor student progress, document eligibility for the program, and for reporting purposes.

CERTIFICATION

Our signatures indicate that, to the best of our knowledge, the information given on this application is true, complete, and accurate.

STUDENT AGREEMENT

If accepted into the program, I agree to attain personal, academic, and career goals that I and Talent Search set for myself.  I also agree to treat myself, other Talent Search students, and staff with respect, and be a positive representative of the program.

As a parent or guardian signing this form, I give permission for my child to participate in all program-sponsored activities. I also give permission to release school records to Talent Search. Additionally, I grant permission to Talent Search to use my name, my child’s name, and/or our photographs for editorial, promotional, recruitment, and/or educational purposes.

STUDENT NEEDS AND POTENTIAL ASSESSMENT

Instructions: To help Thomaston TRIO Staff develop a plan of services for you, we must know what you need.  Please read through the following lists and indicate whether you feel you have a "high need", "some need", or "no need "  for help or improvement in that area.

EDUCATIONAL TALENT SEARCH PROGRAM

1630 Metropolitan Parkway SW

Atlanta, Georgia 30310-4498

 

I hereby grant permission for my son/daughter, {iHereby}, to attend Talent Search sponsored events.  I understand that Talent Search will provide transportation, meals, supervision, and insurance.  I also authorize responding emergency medical services and the hospital admitting the above participant to administer such treatment as is necessary to the participant.  Medical personnel will make every attempt to contact parents or guardians before such treatment is initiated.

CONSENT FOR MEDICAL CARE AND RELEASE FROM LIABILITY: I give my consent for my child to receive whatever medical treatment necessary, proper and consistent with good health practices of the American Medical Association in case of an emergency.  Furthermore, I release Atlanta Metropolitan College and its employees from any liabilities for accidents or normal health difficulties, which may occur during the course of excursion.

EMERGENCY INFORMATION: In case of emergency, please contact either of the adults listed below:

PARENT/GUARDIAN

PARENT/GUARDIAN