Rogue Community College-TS-Participation Form

STUDENT APPLICATION
Rogue Community College
TRiO Talent Search Program
For questions, please call 541-956-7442

TRIO Programs are fully funded by the United States Department of Education. All services are free of charge to participants and hosted by Rogue Community College.

TRiO ETS Participation

Family Information
Parent 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
(999)999-9999
Cell Phone
(999)999-9999
Email*
example@example.com
Parent 2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
(999)999-9999
Cell Phone
(999)999-9999
Email
example@example.com
Language spoken at home

School Age Sibling Information

	Name	Grade (6-12th only)	School they attend
1
2
3
4

Authorization
STUDENT & PARENT CONTRACT: In order for us to serve you with a strong academic, cultural, and collegiate program, we must have a sincere commitment from you. Please carefully review the following:

I, the student, understand that during my participation in Educational Talent Search (ETS):
- My goal will be to complete middle/high school and pursue post-secondary education.
- I will maintain at least a 2.5 GPA in middle school and in high school.
- I will accept appointments and attend all meetings and workshops arranged by my ETS Advisor.
- I will complete all required forms and provide document of completion (FAFSA, Admissions forms, etc.)
- I will abide by all rules and regulations of Educational Talent Search and Rogue Community College.
- Poor attendance or lack of participation will be a basis for dismissal from Educational Talent Search.
Student Name*

First NameLast Name
Today's Date*

MonthDayYear
mm-dd-yyyy
Student Signature*

Clear
I hereby authorize Rogue Community College to use the following identifiable information regarding my child for the purpose of educational publications, promotional advertising and/or other materials or presentations:
- Photographs, images, or likeness
- Information related to child's classroom, school, and/or district
- Student's name
Authorization for Photo Release*

YesNo
I, the parent or guardian, hereby certifies that this information is correct to the best of my knowledge. With my signature, I am granting all TRiO ETS personnel access to the information contained on this form for the purposes of program recording, tracking, and reporting as required by the U.S. Department of Education. I allow TRiO ETS personnel to conduct research pertaining to my child’s educational outcomes as they relate to the TRiO ETS program using phone, email or other digital mediums.

I, the parent or guardian, hereby authorize ETS to contact and request information from, as well as to share information with, the above-mentioned parties both while my child is a participant and afterwards when in college. I give my child permission to participate in ETS activities if accepted. My signature below indicates my commitment to the ETS Student & Parent Contract.

To the best of my knowledge, all information provided in this application is true.
Parent/Guardian Name*

First NameLast Name
Today's Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature*

Clear