Alpena Community College-South-TS-Application Form

Does the applicant participate/qualify for the school's FREE/REDUCED lunch program?*

YesNo

You will need to supply a copy of your income verification with this application. Acceptable types are as follows: Current Federal IRS income tax forms (Federal 1040), benefit statements from Dept. of Social Services, Social Security, Veterans, Pension, or Unemployment. Please send only the pages of your 1040 form which shows the number of dependents (p1) and states your household’s taxable income (line 15). Do not send more than pages 1&2.

Upload School Transcript

Upload current 1040 Tax form only if requested

I certify that all the information on this form is true and complete to the best of my knowledge. I authorize the TS Program to obtain and review any academic, financial, disability, demographic information, or documentation (including eligibility of free or reduced meals programs) from school districts needed for the purposes of data collection and reporting, or progress monitoring, both at the time of my application and throughout my participation in the program.

I authorize my school district to share information regarding my child’s participation in the Free/Reduced Lunch program for the purpose of income verification for the TS program.

I authorize the participants photograph to be used in publication and media posts by the Talent Search program.

I understand that the Talent Search program may use the contact information supplied on this form to contact me/my child by text and email.

I am also aware that the personal information provided to the Talent Search Program will be protected under the Family Education Rights Privacy Act of 1974.

Student Signature*

Student Name

First NameLast Name

Parent/Guardian Signature*

Parent/Guardian Name

First NameLast Name

Date signed*

mm-dd-yyyy