Indian Hills Community College-TS-Application Form

PARENT APPLICATION

Educational Talent Search at Indian Hills Community College is a free, educational program designed to assist 6th through 12th grade participants in their preparation for enrollment into any college of their choice. All information on this application is confidential; your information will never be shared with anyone outside of the Educational Talent Search office.

Student Information

Student Name*

First NameMiddle InitialLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Is English the student’s second language?*

YesNo

Student is:*

Citizen of U.S.Permanent resident of U.S.In the US for other than a temporary purpose and has shown intent to INS to become a permanent residentPermanent resident of Guam, the Northern Mariana Islands, or the Trust Territory of the Pacific (Palau)Resident of the Freely Associated States – the Federated States of Micronesia or Republic of the Marshall Islands

Student’s Social Security Number/A-Number/ITIN. Enter 000-00-0000 if unavailable.*

999-99-9999

USCIS#

Student's Ethnic Origin (select 1 or more races)*

American Indian/Alaskan Native (non-Hispanic)Asian, non-HispanicBlack or African American, non-HispanicHispanic/Latino of any raceWhite, non-HispanicNative Hawaiian or other Pacific Islander (non-Hispanic)

Student is:*

IndependentIn Foster CareWard of the CourtNone of the Above

TOTAL Number of people in household*

Who does the student reside with? (Select all that apply)

Parent Cell #

(999)999-9999

Student Cell #

(999)999-9999

Household Composition

Names of parent/guardian student is living with

Parent/Guardian 1*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Did Parent/Guardian 1 graduate from a 4-year college in the U.S.?*

YESNO

What college?

Cell Phone

(999)999-9999

Email

example@example.com

Parent/Guardian 2

First NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

Did Parent/Guardian 2 graduate from a 4-year college in the U.S.?

YESNO

What college?

Cell Phone

(999)999-9999

Email

example@example.com

You must include your annual taxable income for us to process your application.

Type in your household’s taxable income for the previous calendar year. This can be found on tax form 1040 or 1040-SR line 15.*

OR

Please attach a copy of your most current tax forms if possible.(Taxable income found: Form 1040 or 1040-SR (line 15).)

Browse Files

Sign up additional 6th - 12th grade children for Educational Talent Search below:

	Student Name	Date of Birth	Social Security #	Grade	School
1.
2.
3.
4.
5.

Please list all persons (siblings or other relatives) living in the home and their grades in school:

Your signature below will certify as to the truth of the statements made on this form and will also serve as an authorization for the Educational Talent Search program to request and receive information from your school (including, but not limited to, period report cards, free or reduced lunch status, social security number, standardized test results, use of photographs (including, but not limited to, the ETS webpage and ETS Facebook page), and any information or transcriptions from your school or future college that might be pertinent to the program). It will also imply your permission for the student to take part in all activities related to Educational Talent Search.

Parent's Signature*

Date Signed

mm-dd-yyyy

TRIO Educational Talent Search is 100% federally funded by the U.S. Department of Education in the amount of $277,375 per year.

EDUCATIONAL TALENT SEARCH