California State University-Chico-TS 1-Application Form

Educational Talent Search

California State University, Chico - www.csuchico.edu/tsed - (530) 898-4429
You can switch between the two versions of the application, in Spanish and English, without losing your progress
Dear Applicant and Family,

Congratulations on your dedication to your education and your interest in our program! Educational Talent Search (ETS) is a federally funded program designed to prepare and motivate low-income and/or first- generation college students for success in college. We are passionate about guiding students and their families step by step through the college and financial aid process. Students accepted into the ETS program are participants until they graduate from high school. Meaning that they only need to apply once! All program services are free, but we expect students to make a serious commitment to both their academics and the ETS program. All information provided on this application is confidential and kept in a secure place.

If you have questions or need assistance filling out the application, please call the Educational Talent Search office at (530) 898-4429 during our office hours: Monday - Friday, 8:00 am to 5:00 pm.

Thank you,
Diana Parra-Villaseñor, Director
Application Checklist

Required:
- Student’s Social Security Number
- TOTAL GPA (minimum 2.5)
- First Generation Status (please indicate parents’/guardians’ highest grade level completed)
- Income Status - number of exemptions claimed (including parents), and taxable income from most recent 1040 tax form
- Parent/guardian signature
- Student signature
- Provide documentation if student is under legal guardianship of someone other than birth parents
If you are unsure what your taxable income is, you can find the amount listed on line 15 of Form 1040.
Note that this is NOT the wages, total income or adjusted gross income.
All sections of this application must be completed to be eligible for ETS Services.

*All information must be complete to be eligible for ETS services*
MOTHER'S name:

First NameLast Name
Occupation:
Place of employment:
Telephone number:
(999)999-9999
Email address:
example@example.com
Is the above a work or cell phone #?
Does MOTHER live in the home?
FATHER'S name:

First NameLast Name
Occupation:
Place of employment:
Telephone number:
(999)999-9999
Is the above a work or cell phone #?
Email address:
example@example.com
Does FATHER live in the home?
Guardian's Name:

First NameLast Name
Relationship to student:
Occupation:
Place of employment:
Telephone number:
(999)999-9999
Is the above a work or cell phone #?
Emergency Contact Name:

First NameLast Name
Relationship to student:
Telephone number:
(999)999-9999
Is the above a work or cell phone #?
The student lives in a foster home or is a ward of the court:
The student lives with:

Other
**If student lives with anyone besides the biological parents, please provide proof of legal guardianship.

List all persons currently living in student's home (including the student):

Rows	Name	Age	Relationship to student
1
2
3
4
5
6
7
8

By signing below, I authorize and certify the following:
1. All of the information provided on this application is accurate and correct.
2. Educational Talent Search (ETS) is granted access to my student's school transcripts, class schedules, standardized test scores, and any other information which is necessary for participation of the student in the ETS program.
3. ETS may used my student's picture in program publication materials (brochures, web sites & displays).
4. Should my student require medical attention while participating in ETS activities and I cannot be contacted, I give my consent to medical examination and treatment deemed necessary by the attending medical professional.
5. ETS is granted access to my student's college enrollment, retention and completion information.
6. ETS is granted access to my student's financial aid information from colleges and the federal government.
7. I, the parent/guardian of the above stated student, agree to encourage my son/daughter to attend college immediately following high school graduation.
Parent/Guardian Name Printed:

First NameLast Name
Parent/Guardian Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy

Student, please give your honest opinion about how Educational Talent Search can help you. Your answers will be kept confidential. Mark the box under the number that best describes you, 5 being you need the most help with and 1 being no help at all.

I need to...

Rows	1	2	3	4	5
Hand in homework on a more consistent basis.
Get better grades in school.
Learn how to take better notes.
Learn test-taking strategies and techniques.
Develop strong study habits.
Learn how to ask questions in class.
Have better relationships with my teachers.
Improve relationships with family and friends.
Learn ways to manage stress and adapt to change.
Improve my time management skills.
Learn more about high school graduation requirements.
Learn about courses required to attend a four-year university.
Learn more about college admissions requirements.
Learn about the college application process.
Learn about college entrance exams (for example: SAT/ACT, CAASPP).
Learn about paying for a college education.
Learn how to prepare for a career that interests me.
Learn how to set, assess and evaluate my goals.
Visit colleges/universities to learn about opportunities available to me.
Learn how to strengthen my leadership skills.
Learn how my parents/guardians can help me get to college.

Please list any other topics Educational Talent Search could assist you with:
What type of college are you interested in? (Check as many as you'd like)
Which college campuses are you interested in attending?
Which majors (area of study in college) are you interested in?
Which career(s) are you interested in?

My goal is to continue my education after high school and graduate from college! In order to participate in the Educational Talent Search Program, I agree to:
- Be committed to my education and the ETS program
- Attend ETS workshops and conferences
- Communicate with my ETS Advisor about my educational and personal goals
- Enroll in courses that are required for admission to college
- Achieve and maintain at least a minimum TOTAL GPA of 2.5
- Grant ETS permission to send me texts, calls and email notifications
- Apply for college during my senior year
- Apply for financial aid during my senior year
- Apply for scholarships
- Graduate from high school
- Enroll in the college of my choice the semester after I graduate from high school
- Grant ETS access to my college enrollment, retention and completion information
- Grant ETS access to my financial aid information from colleges and the federal government
- Keep in touch with the ETS program while I am in college to keep them informed of how I am doing
Student Name Printed:

First NameLast Name
Student Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
All personal records and documentations will be held in the strictest confidence by the staff of Chico State ETS, Chico State and Chico State Enterprises. Consistent with the Federal Family Education Rights (FERPA) and Privacy Act of 1974, regulations and other laws, personal records will not be released to any other entity without prior acknowledgement and consent.

Thank you for taking the time to complete the application. We look forward to having you be part of the Chico State Educational Talent Search family!

If you have any questions, please visit our website or give us a call:
www.csuchico.edu/tsed
(530) 898-4429

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Copy of student's Social Security card - Recommended NOT required

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Copy of most recent parent/guardian tax forms for taxable income - Recommended NOT required

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Proof of guardianship - REQUIRED only if student is under legal guardianship of someone other than the birth parents

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Copy of student's most recent transcript - Recommended NOT required

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Educational Talent Search

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