SECTION 1: STUDENT INFORMATION

SECTION 2: NEEDS ASSESSMENT

18. Academic

SECTION 3: SUPPORT SERVICES NEEDED

SECTION 4: WORKSHOPS & ACTIVITIES

SECTION 5: COLLEGE INFORMATION

SECTION 6: FAMILY INFORMATION

26. Parents/Legal Guardian Information

SECTION 7: FAMILY INCOME INFORMATION

29. IMPORTANT: TAXABLE INCOME

Your taxable income for us to process your application!

Please report you taxable information or attach a copy of your most current tax form.

Where to find your TAXABLE INCOME AMOUNT on your most recent tax form:

1040 Form in line 43, 1040EZ Form on line 6. (Note: taxable income is usually quite a bit less than gross and unadjusted income.)

Educational Talent Search is a federally funded program and regulations require verification of family income as part of the application/admission process. All information held in the strictest confidence. This information could also be helpful in assisting your student with information about financial aid, scholarship opportunities and special programs.

SECTION 8: PARENT/GUARDIAN AUTHORIZATION

• I grant permission for Neosho County Community College Eduational Talent Search Program to obtain a copy of my child's middle, high school, and/or college status, grades, transcripts, and test scores concerning behavior and academic progress. I grant permission for use of my child's picture to be in ETS publications, including the website, brochures, and marketing materials.
• I understand that The Privacy of Information Act protects the information on this applicationand by signing this document; I am authorizing my child to participate in Neosho County Community College Educational Talent Search Program and release NCCC from any harm incurred by the student. I certify that all information on this application is true, correct to the best of my knowledge, and agree to provide proof of information upon request by officials of the ETS Program. I understand that completion of this application does not guarantee acceptance into the ETS Program.

SECTION 9: STATEMENT FOR EMERGENCY MEDICAL CARE

Emergency Contact Information

Alternate Emergency Contact

Medical Information on Child

This information needed to better accommodate the child.

Medical Permission for Participant and Staff

In the event my child is injured or is ill, I hereby grant the physician selected to render medical treatment deemed necessary and appropriate and to bill my personal insurance for such incidents. I also hereby grant permission for NON-Prescription medications to be given to my child (i.e. Tylenol, ibuprofen, Pepto-Bismol, anatacid, or throat lozenges) in the event my child complains of an illness.

Release of Liability of Participants and Staff

I understand Talent Search Staff and its agents take all reasonable safety precautions during events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold the Talent Search Program of Neosho County Community College and its staff liable for damages, losses or injuries incurred by the subject of this form.

SECTION 10: STUDENT PLEDGE

The Neosho County Community College Educational Talent Search staff pledges to provide services and activities that specifically meet students' needs. All services are at no cost and are to help increase students potential academically and personally. Services and activities available include:

• Academic Advising
• Campus Tours
• Career Exploration
• Financial Aid Advising
• Cultural Enrichment
• Tutoring

I would like to participate in the NCCC Educational Talent Search program because I share the goals of ETS for students to complete secodary school, receive good grades, and be academically prepared to pursue college level work. As a participant, I agree to the following:

• Strive continually to improve my school grades through good attendance, punctuality, class participation, homework completion, and all other requirements.
• Meet with my ETS advisor at least four (4) times throughout the school year to discuss my current educational status, review my progress toward my goals, and assess my needs.
• Attend ETS school sessions unless they conflict with other academic, extracurricular, or work related obligations or resposibilities.
• Participate in at least three (3) different activities offered by ETS such as:
  • Tutoring
  • Academic Workshops
  • Cultural Events
  • Campus Visits
  • Career Exploration
  • Summer Programs
• Remain in ETS through High School Graduation.
• Encourage parent/guardian to be active in your academics and ETS parent meetings.
• Strive to enter a post-secondary program after high school graduation and ETS participation.
• Cooperate with the ETS staff in the completion and updates of required documentation.
• Cooperate with and respect staff, faculty and other students while participating in ETS activities and traveling on official ETS approved trips.

I agree to the terms of this pledge. My continued participation in Neosho County Community College Educational Talent Search requires that I maintain these responsibilities, unless extenuating circumstances develop.

As the parent/guardian of this student, I recognize the importance of my child's education. Therefore, I commit myself to assisting and/or encouraging my child to fulfill the above ETS contract requirements.

Applicants selected for program participation in compliance with the provisions of section 427 of the U.S. Department of Education's General Education Provisions Act (GEPA). Accordingly, applicants will not be denied access and/or participation based on gender, race, national origin, color, disability, or age. 

This program funded by a grant from the U.S. Department of Education.

Grant number PO44A170486