If you have ever been enrolled in Talent Search, Upward Bound, Upward Bound Math / Science, GO College, or any other program that provides specialized educational programs / services, please complete the following

Do you have a sibling in middle or high school that would be interested in Talent search?

(to be completed by Parent / Guardian)

THE TALENT SEARCH PROGRAM IS A FEDERALLY FUNDED PROGRAM.
FOR THE APPLICANT TO QUALIFY, VERIFICATION OF INCOME IS NECESSARY.
ALL INFORMATION IS CONFIDENTIAL AND FOR PROGRAM USE ONLY

 

Program eligibility is determined, and partially based on, ANNUAL TAXABLE INCOME.

Please indicate the level of your TOTAL FAMILY TAXABLE INCOME for 2023 (taken from the IRS Form 1040 line 43;   1040A line 27; or 1040EZ line 6).  Note: This is not the same as your adjusted gross income – please use TAXABLE INCOME.

For families with more than 8 members, add the following for each additional member: $8,070

ACADEMIC AND CAREER INTERESTS

Before writing your answers, please take time to think about your responses to the questions.

1. In what academic subjects are you getting your highest and lowest grades?

I certify that the family and financial information is true, correct, and complete to the best of my knowledge.  I hereby authorize the Northwest Tri-County Intermediate Unit #5 Talent Search Program Staff to:

• Access my son’s / daughter’s school or agency records to determine eligibility for the program, monitor his / her status and progress in the middle, secondary, and post-secondary education, and determine eligibility for financial aid, including scholarships and grants.
• Access any of my son’s / daughter’s school health records when a medical condition has been disclosed.

• Provide in-school academic support services and career exploration in order to assist and encourage my son/daughter with choices regarding education beyond high school.
• Encourage my son/daughter to obtain before and/or after school tutoring services, if needed, as offered by his / her school district or the Talent Search program.

We understand that, if selected, our son/daughter will be required to attend and participate in meetings, activities, and field trips on an on-going basis, and attend tutoring classes, if needed, until his / her graduation from high school. If possible, he/she will participate in planned summer activities and we will also consider him / her attending, if invited, the five (5) day Summer College Campus Experience at Penn State Behrend. This application remains in effect until my son/daughter and I notify his / her, Academic Specialist, in writing, that he/she no longer wishes to participate in the Talent Search Program.

To add your signature, sign using your mouse or finger on a touch screen