The Renaissance Education Group Inc.-Durham-TS-Application Form

Renaissance Talent Search

Application
Be sure to answer all questions and print or type clearly.
If unable to submit application online, please email or fax to:
The Renaissance Talent Search Program
pcu@renaissance-ed.net
Fax: (866) 770-4766

This form will be used to determine eligibility for program services. Form must be signed by both the student and parent/guardian. Please complete this application in full before submitting. All of the information collected will be held in the strictest of confidence. Applications will be processed once all materials are received. Admission into the program will be based on eligibility, need, and readiness for the program. For additional questions, please call (919) 416-1736.

Parent/Guardian Information
Mother/Guardian Name:*

First NameLast Name
Mother/Guardian Cell #:
(999)999-9999
Mother/Guardian E-mail:*
example@example.com
Father/Guardian Name:*

First NameLast Name
Father/Guardian Cell #:
(999)999-9999
Father/Guardian E-mail:*
example@example.com
Please answer all questions below:
Has either parent received a 4-year degree from a college or university?*

YesNo
Is your child eligible for free or reduced lunch?*

YesNo
Is your child or his/her family homeless?*

YesNo
Is your child in foster care?*

YesNo
How many people are living in your household (including yourself)?*
Parent/guardian, please select your total taxable income.*
By signing this document, I, the parent/guardian certify that the information provided on this form is true and complete to the best of my knowledge, I authorize the minor child to participate in this program, and I agree to adhere to all policies and procedures in the student and parent handbook. Further, I, the parent/guardian authorize the agency to access or receive copies of my child’s academic and school records to complete the application process for academic assessment, program evaluation, and mandatory reporting. For federal reporting purposes, this release is good for ten years post signature.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Admission into the Renaissance TS Program is open to those who meet eligibility criteria, regardless of gender, race, national origin, color, age, religion, or disability (USDOE – GEPA Section 427).

The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, is the law providing for the review and disclosure of student educational records. TRIO will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent of the student, except as authorized by FERPA.

Renaissance Talent Search