Marshall University-Heart Of Appalachia-TS-Application Form

HATS PROGRAM APPLICATION
Heart of Appalachia Talent Search Program?
The HATS Program is a federally funded TRIO Program that provides academic support to students in Mason and Wayne county middle and high schools. Partnering with each school, HATS staff members are committed to helping students reach their full potential by connecting them with the resources needed to successfully transition into a technical school, community college or university.
WHAT SERVICES WILL I RECEIVE AS A MEMBER OF HATS?

Career Exploration
College Exploration
Financial Aid Counseling
ACT/SAT Prep
Cultural Enrichment

Improving Study Skills
College Campus Visits
STEAM Activities
Tutoring Connection
Leadership Opportunities

CAN ANYONE APPLY?
Any middle or high school student attending school in Mason or Wayne County is welcome to apply to be a part of the HATS Program. However, priority is given to students whose parents have not completed a four-year college degree or whose family income meets certain federal guidelines. All students must demonstrate that they want to be an active member of the program and can benefit from the services that are offered.
HOW CAN I APPLY?
1. Complete the entire HATS Application
2. If you have questions, contact the HATS Office at 304-696-2941
3. Return the application to the HATS Advisor at your school, your counselor or mail it to our office at:
Gullickson Hall 210

One John Marshall Drive

Huntington, WV 25755-2195-104
Please read this application carefully and answer all questions completely. This information that you provide will be kept confidential. Remember, if the application is not complete, it will prevent us from admitting the student into the HATS Program in a timely manner.

PARENT/GUARDIAN ONE INFORMATION
Parent/Guardian One Name:*

First NameMiddle NameLast Name
Parent/Guardian One Relationship to Student:*
Is this individual living in the home with the student?*

YesNo
Did Parent/Guardian One complete a four-year college degree?*

YesNoOther
If so, what was Parent/Guardian One's major:*
College where degree was obtained:*
What is Parent/Guardian One's current employment status?*

EmployedUnemployedPermanently DisabledTemporarily Disabled
If employed, place of employment:*

PARENT/GUARDIAN TWO INFORMATION
Parent/Guardian Two Name:

First NameMiddle NameLast Name
Parent/Guardian Two Relationship to Student:
Is this individual living in the home with the student?

YesNo
Did Parent/Guardian Two complete a four-year college degree?

YesNo
If so, what was Parent/Guardian Two's major:
College where degree was obtained:
What is Parent/Guardian Two's current employment status?

EmployedUnemployedPermanently DisabledTemporarily Disabled
If employed, place of employment:

HOUSEHOLD INFORMATION:
How many people currently live in your home (including yourself)?*
Did you file an income tax return last year? (Line 15)*

YesNo
If yes, what was your TAXABLE income for last year?*
If you did not file an income tax return, what was your source of family income for last year?*

Unemployment IncomeSocial Security IncomeSSI IncomePublic AssistanceOther (please indicate source)
Income or Custody/Legal Documentation

Cancelof

PARENT AND PARTICIPANT AGREEMENT:
The signatures below approve and acknowledge the following:
- The release of any school, college or university records to the HATS Program with the understanding that these records are held confidential in accordance with state and federal laws.
- My cooperation with HATS staff and encouragement of my child to abide by the rules of the program participation which include:
  - Attending HATS meetings during the school day (more than two unexcused absences may result in dismissal from the program).
  - Demonstrating respectful behavior and a positive attitude when participating in HATS activities and events
  - Notifying the HATS program at least 48 Hours in advance if cancelling attendance in a program workshop, trip or overnight event.
- The right to photograph or film the student during HATS activities and use their likeness in HATS materials and media releases.
- To my knowledge, the information provided in this application is true, correct, and complete.
Student Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Parent Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy

ACADEMIC RECORD RELEASE
(Due to federal reporting requirements, we must have access to this information for your child to participate in our program)

I hereby authorize the release of the records indicated below to the Marshall University Heart of Appalachia Talent Search (HATS) Program for
Student Name*

First NameLast Name
This information will be used to assist with improving academic performance as well as to monitor long-term post-secondary enrollment and success.
1. Records contained within the WVEIS data system including:
  - Student ID Number
  - Attendance Record
  - Verification of Grade Level
  - Class Schedule
  - Grade Reports
  - Student Standardized Achievement Test Scores
  - Transcripts
2. Records related to college application status and college enrollment as provided by post-secondary institutions and/or the National Student Clearinghouse database.
3. Records related to FAFSA Completion and Verification Status as per agreement with the WV Higher Education Policy Commission and/or post-secondary institution where the student may apply/attend.
4. ACT/SAT test scores obtained through the use of the HATS School Code for exam fee waivers.
The release will be in effect through the student’s completion of high school and for six years following their graduation to allow for annual follow-up of HATS participants as is required by the U.S. Department of Education regulations to evaluate the HATS Program. I understand that this information will be held in compliance with the Family Education Right to Privacy Act (FERPA) and other applicable federal and state laws. Student records will only be accessible to the appropriate HATS Program staff members and the U.S Department of Education officials who monitor the HATS Program grant for compliance. All records will be safely secured as outlined by federal law.
Student Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Parent Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy

HATS PROGRAM APPLICATION

Heart of Appalachia Talent Search Program?

WHAT SERVICES WILL I RECEIVE AS A MEMBER OF HATS?

CAN ANYONE APPLY?

HOW CAN I APPLY?