Clark Atlanta University-LaGrange-TS-Application Form

The mission of Educational Talent Search (ETS) is to encourage participants to graduate from high school and continue on to the postsecondary institution of their choice. ETS is funded by the U. S. Department of Education through Clark Atlanta University.

Blank or incomplete applications will not be accepted. All information is confidential.

Is the student a US Citizen?*

YesNo

Is the student a permanent resident?*

YesNo

Thank you for attempting to submit an ETS Lagrange Application for the 2022-2023 school year. The U.S. Department of Education stipulates in order to qualify for our program, a student must be a U.S. Citizen or permanent resident. Based on the response you entered, we are unable to consider you for our program at this time.

We wish you every success in your educational pursuits!

Student's Name:*

First NameLast Name

Student's Birthdate:*

mm-dd-yyyy

Address*

Street Address & APT #

Street Address Line 2

CityState / Province

Postal / Zip Code

Student's Email: *

example@example.com

Student's Phone Number:*

(999)999-9999

Sex:*

MaleFemale

Ethnicity:*

African American or Black, non-hispanic/latinoAsian, non-hispanic/latinoWhite, non-hispanic/latinoHispanic/Latino of any raceNative American, non-hispanic/latinoNative Hawaiian or other Pacific Islander, non-hispanic/latinoTwo or more races, non-hispanic/latino

What school do you currently attend?*

What grade are you in for the 2024-25 school year?*

Are you dual enrolled?

YesNo

#1 Parent/ Guardian's Name with whom you live:*

First NameLast Name

Phone Number:*

(999)999-9999

Email:*

example@example.com

#2 Parent/ Guardian's Name with whom you live:

First NameLast Name

Phone Number:

(999)999-9999

Email:

example@example.com

Did either of the parents you live with receive a Bachelor's degree or higher?*

YesNo

Number of people in household:*

Indicate your household adjusted gross income. (Gross income minus any deductions or exemptions) *

Is your child an applicant to receive free lunch?*

Who were you referred by? *

Please answer yes or no to the questions below *

	Yes	No
Are you currently participating in any other TRiO programs such as Upward Bound (UB) or (UB) Math and Science?
Have you ever made the honor roll?
Have you ever failed a class?
Have you ever considered dropping out of school?
Do you need guidance to improve study skills?
Do you know the Georgia high school graduation requirements?
Have you begun preparation for the PSAT/ACT/SAT?
Do you need college application or SAT/ACT fee waivers?
Have you decided on a career?
Do you know the college major for your desired career?
Have you decided on which college that you would like to attend?
Have you requested information from the college of your choice?
Do you need assistance with applying for Financial Aid?
Do you need assistance with applying for scholarships?

What are your plans after high school graduation?*

CollegeWorkMilitary

How often do you meet with your middle or high school counselor?*

WeeklyMonthlyOnce a Semester

List extracurricular activities you participate in, if none enter NA.*

List subjects tutoring is needed, if none enter NA.*

Media Release

The Clark Atlanta University, Educational Talent Search (CAU-ETS) program occasionally uses photos/videos of participants and events in its publications and on its website.By signing below, I understand that my student’s image may appear in a CAU-ETS publication or on the program’swebsite.

Authorization to Release Information

I understand that it is required for the listed student to attend ETS activities which will include sessions during school hours. I authorize CAU-ETS personnel to obtain copies of transcripts, grade reports, test scores or any other information necessary to determine eligibility for services. In addition, I acknowledge that ETS staff will communicate with the student as necessary and authorization is granted to obtain college acceptance and enrollment information.

Privacy Act

I understand this information will be kept in strict confidence and will be used to evaluate the ETS participant’s progress from 6th grade through college in accordance with the Family Educational Rights and Privacy Act. The Clark Atlanta University Educational Talent Search program does not discriminate on the basis of sex, race, age, national origin, religion or handicap.

I certify that all information provided is true and accurate to the best of my knowledge.

Student's Signature*

Parent/Guardian's Signature*

Today's Date*

mm-dd-yyyy

Please attach a picture of yourself to be used as a profile picture.

Clark Atlanta University Educational Talent Search - LaGrange

Student/Applicant Assessment