Gadsden State Community College-Harry M. Ayers-TS-Application Form

Ayers Campus Talent Search
Participant Application
Thank you for your interest in the Talent Search program at the Ayers Campus! Please complete this application as thoroughly as possible. You cannot save and restart this application. Please complete the application carefully. Be sure to complete all fields. Incomplete applications cannot be processed.
- Student Name
  
  First NameMiddle InitialLast Name
- Preferred Name
  Ex: Becky for Rebecca
- Current School
- Current Grade Level
- Address
  
  Street Address
  
  PO Box
  
  CityState
  
  Zip Code
- Social Media Contact Information
  Ex: John Doe - Twitter or JDoe - Instagram
- Student Email #1
  example@example.com
- Student Email #2
  example@example.com
- Student Cell Phone Number
  (999)999-9999
- Alternate Phone Number
  (999)999-9999
- Birth Date
  
  MonthDayYear
  mm-dd-yyyy
- Current Age
- Gender
- Are you a U.S. citizen?
- Ethnicity
- Race
- Do you have a documented disability?
- Additional Comments
- Did you earn a "C" or better in each class on your most recent report card?
- What are your plans after graduating from high school?
  
  Other
- List any colleges that are of interest to you.
- Who does the student live with?
- Parent or Guardian Name
  
  First NameLast Name
- Parent or Guardian Name
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Marital Status
- Cell Phone Number
  (999)999-9999
- Alternate Phone Number
  (999)999-9999
- Email
  example@example.com
- The best way to contact me is
- Please provide alternative contact information for your child (ex: other parent, grandparents, adult sibling, etc.):
- Name
  
  First NameLast Name
- Phone Number
  (999)999-9999
- Name
  
  First NameLast Name
- Phone Number
  (999)999-9999
- The Talent Search program is 100% funded by the U.S. Department of Education and it requires information related to household income level and parent educational background. The information provided will be used to determine student eligibility for participation in the Talent Search program.
- Does either parent/guardian living with the student have a bachelor's degree (4-year degree)?
- How many people live in your household , including yourself?
- Does your child qualify for free or reduced priced lunch?
- What was your household's TAXABLE income last year? Indicate range below. Please check your TAXABLE income for last year (line 43 on 1040 form, line 27 on 1040A form, line 6 on 1040EZ form). By signing this form you are certifying the income information provided is accurate and that you understand it may be used to determine student eligibility.
- What Talent Search services does your child want or need to receive?
- Please provide any further information about your child that you feel the ACTS program may need:
- I give my child permission to participate in meetings/activities with the Talent Search program at his/her school during the school day, as needed and allowed by the school.
  
  I authorize the release of educational records of my child including (but not limited to) grades, test scores, free/reduced lunch eligibility, class schedules, attendance and behavior reports for the duration of his/her program participation. Records will be used to assess student needs, monitor academic progress, document eligibility and for reporting purposes. This information is confidential and protected under The Family Education Rights and Privacy Act (FERPA).The Talent Search program will not release any confidential information without your written consent.
  
  I authorize the use of my child's photograph for editorial and/or advertising purposes, social media, recruitment, newsletters, brochures, workshops, and videos for the duration of his/her program participation.
  
  I authorize the postsecondary institution that my child attends to release admissions information, proof of enrollment, and scholarship award information to the Ayers Campus Talent Search program.
- Name of Child
  
  First NameLast Name
- I certify that the information provided in this application is correct and true to the best of my knowledge.

Ayers Campus Talent Search