Spartanburg Community College-TS-Application Form

Spartanburg Community College-TS-Application Form

Complete (ALL PARTS) of the Application with REQUIRED signatures & dates
- Student's Full Name
  
  First NameLast Name
- Goes by
- Gender
- Birth Date
  
  MonthDayYear
  mm-dd-yyyy
- Age
- Mailing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Home Phone
  (999)999-9999
- Student Cell Phone
  (999)999-9999
- Student E-mail Address
  example@example.com
- Name of School:
- Grade Level:
- Expected Graduation Year
- Are you a dual enrollment student?
- ETHNIC BACKGROUND (Ethnic information is for statistical summaries only, and will not be a factor in program eligibility). Check all that apply
  
  Other
- Name
  
  First NameLast Name
- Relationship to student
- Email Address
  example@example.com
- Cell Phone
  (999)999-9999
- Employer
- Work Phone
  (999)999-9999
- This parent/guardian has a 4-year college degree:
- Name
  
  First NameLast Name
- Relationship to student
- Email Address
  example@example.com
- Cell Phone
  (999)999-9999
- Employer
- Work Phone
  (999)999-9999
- This parent/guardian has a 4-year college degree:
- Please check all topics for which you would like to receive information, counseling and/or assistance:
  
  Other
- Please check one of the following sentences that best describes your educational goals.
- I am interested in the following:
  
  Other
- By completing this application, the applicant agrees that he or she has the abilities and interest to pursue academic classwork that will lead to continuing education after high school. Completion of the application indicates applicant’s desire to become a Talent Search Scholar and participate in TRIO TS program activities and events. TS is a federally funded program sponsored by Spartanburg Community College.
- We are required by the U.S. Department of Education to gather family income and other eligibility information from all participants served by the TRiO Talent Search Program. All information will be held in strict confidence.
- Student's Name
  
  First NameMiddle NameLast Name
- School Attending
- Grade Level
- Birth Date
  
  MonthDayYear
  mm-dd-yyyy
- Is student a United States citizen?
- A birth/adoptive parent (with whom the child lives) has earned a baccalaureate/bachelor's degree.
- If yes, indicate below the parent’s name, college and degree earned and graduation year.
- College/University
- 4-year College Bachelor Degree
- Parent's Name
  
  First NameLast Name
- College Graduation
- College/University
- 4-year College Bachelor Degree
- Parent's Name
  
  First NameLast Name
- College Graduation
- PLEASE INDICATE THE FOLLOWING
- Size of Family (including yourself): (check one)
- Income: (check one)
- Taxable Family Income Actual Amount:
- 1. Annual taxable household income; if income fluctuates, refer to last year's tax return
  $
- 2. Non-taxable household income (if any)
  $
- 3. If no taxable income, please place zero here
  $
- 4. Including yourself, how many people live in your home
- I declare that the information given here is correct. I authorize the school counselors, school district office, middle and high school officials, institutions and/or agencies to release any recorded information to include transcripts and report cards; Power School information and access; EXPLORE, PLAN, SAT, ACT, PSAT and PASS testing; Individual Graduation Plans (IGPs); academic, financial, and/or other information on my child’s behalf to the ETS staff with the understanding that this information will be used only in regard to ETS services and is protected by the Privacy Act (FERPA).
- Parent/guardian's Signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy
- I hereby give the Spartanburg Community College, its agents, employees, servants, assigns and successors, without expectation of value, permission to:
  
       1. Record my child’s likeness and appearance on video tape, audio tape, film, photograph or any other medium; and
  
       2. Use my child’s name, likeness, voice, and biographical material in connection with these recordings; and
  
       3. Exhibit, copy or distribute such recording in whole or in part without restrictions or limitation for any educational or promotional purpose or advertisement campaigns which the University of South Carolina, and those acting pursuant to its authority, deem appropriate.
- Student's signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy
- Parent/guardian's signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy

Spartanburg Community College-TS-Application Form

PLEASE INDICATE THE FOLLOWING