Southwestern Michigan College-TS-Application Form

Educational Talent Search
at Southwestern Michigan College
Student Application

58900 Cherry Grove Road Office: (269) 782-1472

Dowagiac, Michigan 49047

General Information
Dear Parent or Guardian,

Your child has been given the opportunity to participate in Educational Talent Search (ETS), one of the TRiO programs of the U.S. Department of Education. Our program’s mission is to help students succeed in school, explore career interests, and then link them to the education/training needed after high school that will help make their goals come true.

There is absolutely NO CHARGE to students or parents for Educational Talent Search services and materials. We believe that your child is eligible to receive our services. In order to confirm your child’s eligibility, it is necessary for you and your child to complete this form and return it to the school or to the ETS advisor. Upon remittance, ETS staff will review this application and notification will be given as to the student’s status for the ETS program. Because we are federally funded we must receive this information to confirm services are being provided to eligible students. THE ENTIRE FORM, INCLUDING ALL LINES, MUST BE FILLED OUT IN ORDER TO BE ADMITTED INTO THE PROGRAM. ALL INFORMATION IS KEPT CONFIDENTIAL.

We are looking forward to working with your child. We hope to prepare him/her for a successful future by stressing the importance of education and training. If you should have any questions, please feel free to call the ETS office at (269) 782-1472.

Sincerely,

ETS Staff

Bethani Eichel, Director
Allyson Harris, Advisor
Karli Wendorf, Advisor

Student Assessment Inventory

The column that best describes how you feel about each idea*

	Easy	A Bit Difficult	Difficult
Seeing school as a positive experience.
Asking my teacher or others for help.
Paying attention in class.
Keeping focused on my work at home.
Thinking about the consequences my actions have.
Asking for a tutor when I need help.
Setting short term and long term goals for myself.
Knowing what foods are healthy and nutritious for my body.
Having confidence in my abilities as an individual.
Being part of a team. Being able to work with groups of people.
Studying for tests- knowing what I need to study and if I understand the information.
Taking tests.
Dealing with stress.
Balancing school, family, work, and friends (time management).
Participating in an event/activity that’s outside my comfort zone.
Graduating from high school.
Knowing about various career pathways.
Making plans after high school including going to college.
Knowing where to get money for college or job training.
Knowing who to ask for help with planning for after high school.

Please answer the following questions:
What are your favorite subjects and classes in school?*
Which classes do you feel you might need tutoring?*
Do you know what TIP is?*

YesNo
Do you plan on going into the military after high school?*

YesNo
If Yes, what Branch?
Do you plan on going to college after you graduate from high school? *

YesNo
Have you ever visited a college campus?*

YesNo
Do you know what FAFSA is?*

YesNo
Do you own a computer?*

YesNo
Do you have access to the Internet at home?*

YesNo
Student Signature*

Clear

Information & Photo Release
Information Release

In order to offer your child individualized advising for their academic success, we will need to have access to their school records. Please read the following statement:

I/We hereby authorize the release of information concerning the academic progress and success of my child, including copies of school records, financial aid information, and available test scores to Educational Talent Search. It is my/our understanding that all information received from school personnel and representatives of other agencies or institutions will be kept confidential in compliance with the Family Education Rights and Privacy Act. Further, I authorize ETS representatives to communicate with representatives from agencies or post-secondary institutions on my child’s behalf. I/We also give permission to ETS staff to take photos of my/our student to be used for ETS purposes.

I, the undersigned, grant permission for EDUCATIONAL TALENT SEARCH to take and use visual/audio images of my child which may include photographs, digital images, drawings, video recordings, audio clips with accompanying written descriptions. The image may be published in ETS materials such as web pages, newsletters, annual reports, promotions, broadcasts, advertisements, posters or presentations.
Educational Talent Search has permission to meet one-on-one or in a small group with my child during the regular school day.*

YesNo
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Photo Release

I, the undersigned, grant permission for EDUCATIONAL TALENT SEARCH to take and use visual/audio images of my child which may include photographs, digital images, drawings, video recordings, audio clips with accompanying written descriptions. The image may be published in ETS materials such as web pages, newsletters, annual reports, promotions, broadcasts, advertisements, posters or presentations.
Name of Student*

First NameLast Name
Parent/Guardian signature (if student is under 18 years ofage)*

Clear
Phone*
(999)999-9999