Sound Mind Sound Body Foundation-TS-Application Form

  • PARTICIPANT APPLICATION
    Please type or print in blue or black ink. (Please do NOT use white-out!)

    • STEP 1: Student, please answer the following questions about yourself. 
    • This parent's cell phone number belongs to...*
    • This parent's email belongs to...*
    • g. Which parent do you regularly reside with and receive support from?(Please check only one box.)*
    • STEP 2: Student, please answer the following questions about yourself. 
    • d. What is your birthdate?*
       - -
    • e. What is your gender?*
    • What sport do you play at school?*
    • STEP 3: Student, please answer the following question about yourself. 
    • a. Are you a U.S. citizen?*
    • STEP 4: Student, please answer the following questions about yourself. 
    • Rows
    • STEP 5: Determination & Assessment of Student Need for Project Services 

    • (34CFR643.32(c)(1-2))

    • What three careers interest you the most?

    • Do you plan to go to college? Note: “College” can mean a community college, university, or trade school*
    • Which services do you need in order to prepare yourself for college? (34CFR643.4) Check the box(es) next to each service you need.*
    • Date*
       - -
    • STEP 6: Parent section- Parents must answer the following questions about themselves 
    • Income
    • b. What was your family’s taxable (not total) income from the last calendar year? (Please check only one box. Then, provide the requested income information.) Note: Taxable income can be found on the federal income tax return. On IRS Form 1040, see line 10.*
    • c. Has the mother of the student received/earned a four-year college degree?*
    • d. Has the father of the student received/earned a four-year college degree?*
    • STEP 7: You (the student) must read the following statement and then sign and date below it. If you (the student) are less than 24 years old and answered NO to all the questions in STEP 5, your parent must also read the following statement and then sign and date below it. 

    • By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the student’s official academic records to the TRIO Talent Search project, understanding that the information in these records will be used only to assess the student’s need for TRIO program services, discern the student’s educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program-reporting requirements. Finally, I authorize the TRIO Talent Search project to use the student’s name, statements and likeness, without charge, for promotional purposes in project publications, advertising, video, and other formats.

    • Date*
       - -

    • I understand by signing this form, I consent to the release of any relevant academic and behavioral student records to the Sound Mind Sound Body Foundation to conduct academic evaluations. I understand the information may be released orally or in the form of copies of written records, as preferred by the requester. I understand I may revoke this consent upon providing written notice to the school. I further understand that until this revocation is made, this consent shall remain in effect and my student's educational records will continue to be provided to [Sound Mind Sound Body Staff to whom the educational records will be released] for the specific purpose described above.

    • Date*
       - -
    • Submit 
    • Should be Empty: