CUNY Brooklyn College-TS-Application Form

The Federal TRIO Programs are outreach services designed
to identify and provide services for students from disadvantaged backgrounds. In 1965, as part of the Higher Education Act, TRIO created Talent Search to help low-income high-school students be the first generation in their families to attend college and attain a Bachelor’s degree. With the goal of bridging the gap for our students, Brooklyn College’s Talent Search supports them by providing:
- Regents and SAT Prep Tutoring,
- Academic, Career, and Financial Counseling
- College Readiness Workshops
- Learning and Study Strategies Assessments
- Assistance with College Enrollment Applications
- Single-day College Trips and Overnight College Tours
- Summer Enrichment Activities…and more
OUR VISION IS A SOCIETY WHERE ALL WHO ASPIRE TO LEARN, WILL OBTAIN THE HIGHEST EDUCATION ACHIEVABLE!

Educational Talent Search Program
Brooklyn College
2900 Bedford Avenue
Ingersoll Hall 1428
Brooklyn, NY 11210

For more information about the program contact:
ADMINISTRATIVE OFFICE: 718.951.5593
COUNSELOR OFFICE: 718.951.4121
FAX: 718.951.5680
EMAIL: EducationalTS@brooklyn.cuny.edu
VISIT US: brooklyn.cuny.edu/talentsearch
FOLLOW US: talent_search_bc | facebook.com/BCTRIO.ETS

Caregiver Information
Mother/Female Guardian Name*

First NameLast Name
Parent Telephone Number*
(999)999-9999
Type of Phone*

HomeCell
Email*
example@example.com
Father/Male Guardian Name*

First NameLast Name
Parent Telephone Number*
(999)999-9999
Type of Phone*

HomeCell
Email*
example@example.com
The Student resides with*

Mother/Female GuardianFather/Male GuardianBothOther

Student Educational Information
1. School Applicant Currently Attends*
2. OSIS Number
3. Current Grade Level*
4. Expected Date of Graduation
Please attach your updated transcript or report card (Optional)

Browse Files

Cancelof

Applicant Signature of Verification
I understand that my participation in the Educational Talent Search Program is a commitment until I graduate high school and enter college. I will attend all Educational Talent Search activities that are recommended for me this school year (September 1, 2020 to August 31, 2021), and each school year thereafter until I enter college.
Applicant Name

First NameLast Name
Signature of Applicant

Clear
Date

MonthDayYear
mm-dd-yyyy

Emergency Contact Information
Please list at least one person who is not a parent/guardian who can be contacted in the case of an emergency. Please include the address, telephone number and relationship to the child.
Name #1*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Telephone #
(999)999-9999
Relationship
Secondary Telephone # (if applicable)
(999)999-9999
Name #2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Telephone #
(999)999-9999
Relationship
Secondary Telephone # (if applicable)
(999)999-9999
In case of an emergency, if the previously named parents/guardians cannot be contacted, or if time is an important factor, I authorize the staff to take the most reasonable action possible in the situation.

Under penalties of immediate expulsion from the program, reimbursement of all funds allocated to services to the applicant, and/or possible legal actions, I declare that I have examined all sections of this application and its statements, and to the best of my knowledge and belief, they are true, correct, and complete.
Parent/Guardian Name

First NameLast Name
Signature of Parent/Guardian

Clear
Date

MonthDayYear
mm-dd-yyyy
How did you find out about TRiO Educational Talent Search?

School PersonnelSchool CounselorFriend/FamilyWeb SitePaper AdvertisementSocial MediaAlumniOther
If you selected School Personnel, School Counselor, or Friend/Family, please specify below

Student Records Release
Student Name

First NameLast Name
As part of participation in the Brooklyn College Educational Talent Search Program (BCETSP) TRIO, I hereby consent to the release of all personal and academic related documents (birth certificate, transcripts, etc.) related to my son/daughter by my son/daughter’s high school to BCETSP. I understand that access to my child’s personal and academic documents will help expedite and advance the start of service and type of support he/she receives by BCETSP. I understand that this information will not be shared with any third-party institution and will be held confidential and exclusive to BCETSP staff.
Parent/Guardian Name

First NameLast Name
Signature of Parent/Guardian

Clear
Date

MonthDayYear
mm-dd-yyyy

Media Release Consent
Check only one of the following

I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the student named above by the Brooklyn College Educational Talent Search Program. I also grant to Brooklyn College Educational Talent Search Program the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release Brooklyn College, CUNY and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.I do not consent to the use of my student's photo/image.
Parent/Guardian Name

First NameLast Name
Signature of Parent/Guardian

Clear
Date

MonthDayYear
mm-dd-yyyy

Getting to Know You Questionnaire
1. Student's full name and/or nick-name

First NameLast Name
2. Does the student fluently speak a language(s) other than English (including Sign Language)?

YesNo
3. If you answered “yes” in 2, please list the language(s) here
4. What are the hobbies, talents or skills of the student?

5. Please select all of the Regents, PSAT and SAT examinations the student has completed. Provide their scores if possible.

	Score
English
Algebra I
Algebra II (Trigonometry)
Geometry
Chemistry
Earth Science
Living Environment
Physics
Global History
U.S. History

PSAT/Scores

	Score
Service Quality
Cleanliness
Responsiveness
Friendliness

SAT/Scores

	Score
Math
Reading
Writing

6. What career occupations closely align with the student’s career goals? Please select all that the student is seriously interested in.

AccountantArchitectAutomotive TechnicianBusiness Owner/EntrepreneurComputer Scientist/Analyst/DesignerConstruction WorkerCosmetology/Hair DressingCounselorCulinary Chef/RestauranteurDentistEngineerFashion DesignerFinancierFire FighterFitness Trainer/Sports CoachGraphic DesignerLawyerNurseParamedicPharmacistPhysical TherapistPhysician/DoctorPolicy/Government OfficialProfessional AthletePsychologist/PsychiatristRealtorScientist/BiologistSecurity/Police OfficerSocial Service/Human Relations AgentSurgeonTeacher/Educator/PrincipalVeterinarianOther
7. Please briefly describe the exact specialty or the profession the student is interested in
8. Select all post-secondary institutions the student is interested in attending after graduating high school

CUNY City University ofNew YorkSUNY State University ofNew YorkHBCU Historically BlackCollege/UniversityState of NY (Private)Out of State (Public)Out of State (Private)Vocational SchoolIvy LeagueMilitary
9. What is the highest educational degree the student desires to achieve after graduating high school?

2-YearAssociate’s Degree4 -Year Bachelor’s DegreeMaster’s DegreeDoctorate’s DegreePost-Graduate DegreeNone
10. Does the student have an IEP?

YesNo
11. Does the student receive any additional services or accommodations in school?

YesNoNot Sure
12. If yes, please specify (e.g. More time on tests)
Brooklyn College | 2900 Bedford Ave | Ingersoll Hall 1428 & 1424
718.951.5593 (Admin) | 718.951.4121 (Counselors) Updated 1.27.2020

Form	Line #
1040	37
1040A	21
1040EZ	4