267466-University Of Texas-Rio Grande Valley-Edinburg-TS-Application Form-Ian

Talent Search Edinburg Student Participant Application

INCOME INFORMATION
INCOME INFORMATION
What is the annual taxable family income after deductions (Form 1040 Line 15) from the 2022 Income Tax forms? (If taxes weren’t filed, please give an estimate of income to the best of your knowledge.)*
How many people live in the household, including the student?*
ALL INFORMATION RECEIVED IS FOR ETS USE ONLY AND WILL BE KEPT STRICTLY CONFIDENTIAL.

I certify that the above information is true, complete, and correct to the best of my knowledge. Furthermore, I grant the Talent Search Program permission to receive copies of educational records & other materials necessary for participation in the program.

Disclosure of your Social Security Number (“SSN”) is required of you in order for The University of Texas Rio Grande Valley Educational Talent Search Program to track and report to the U.S. Department of Education, as mandated by Federal law. Further disclosure of your SSN is governed by the Public Information Act (Chapter 552 of the Texas Government Code) and other applicable law.
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
The University of Texas Rio Grande Valley does not discriminate on the basis of race, color, national origin, religion, sex, age, veteran status or disability.

The Educational Talent Search Program is funded by U.S. Department of Education $502,050.00.

Program Consent
Educational Talent Search Program Consent Form

Program Director: Jennifer Soto

ECESS Building Room 1.600

(956)665-7590

Dear Parent(s):

My son/daughter, {main_name} , and we are being asked to participate in the Educational Talent Search Program (ETS). Our participation in this program is entirely voluntary and we may refuse to participate or may decide to cease participation at any time. Should we decide to withdraw or refuse to participate in the program, our decision will involve no penalty but will result in loss of services to which we are otherwise entitled. We are also aware that no financial compensation will be offered for participation in the Educational Talent Search Program.

We are aware that the purpose of the ETS Program is to provide educational outreach to students within school districts Edcouch-Elsa, ISD, Mission, CISD, and La Joya ISD. The objectives of the Educational Talent Search Program are: 1) to identify qualified participants with potential for education at the post secondary level, 2) to encourage and assist them to continue in and graduate from high school, and 3) ultimately enroll them in a post secondary program. We are aware that all students will be recommended to tutoring in areas of academic weaknesses, and receive peer mentoring, career and educational guidance (i.e. admissions, financial aid applications and introduction to different career options) as well as field trips to Texas universities. The program will provide a comprehensive outreach campaign to publicize the availability of financial assistance for eligible participants.

We are aware that the total anticipated time span for each student involved in the Educational Talent Search Program will last from the time the student enters the program until his/her high school graduation. We are also aware that our participation in all activities is of great importance. If my child’s participation does not meet the standards of the Talent Search Program, we are aware that we may become deactivated from the program and may no longer be permitted to participate in the program’s activities.

Every effort will be made to maintain the confidentiality of my child’s records. In no way will my child’s records be revealed. We have been advised that the data collected from the program will be used for educational purposes. The identity of all the students will be kept in a secure location available only to the Educational Talent Search staff and Associate VP for College Access and K-12 Partnerships Ms. Cynthia Valdez.

We have been told that the ETS staff has the right to withdraw us from the program at any time. The Educational Talent Search staff has offered to answer all our questions if we have additional questions or comments during our tenure in the TS program, we may contact Ms. Cynthia Valdez, AVP for College Access and K-12 Partnerships at 956-665-2522.

My signature below acknowledges our voluntary participation in the Educational Talent Search Program. Such participation does not release the ETS staff and institution from their professional and ethical responsibility to my child. We understand the information provided above and had our questions answered to our satisfaction.
Student Name*

First NameLast Name
School / Grade*
Signature of Parent *

Clear
Date*

MonthDayYear
mm-dd-yyyy
The University of Texas Rio Grande Valley does not discriminate on the basis of race color, national origin, sex, age, veteran status or disability.

The Educational Talent Search Program is funded by U.S. Department of Education $502,050.00.

Parent Consent / Release Agreement
Educational Talent Search Program
Parent Consent / Release Agreement Form

I hereby give permission for my son/daughter to participate in the Educational Talent Search Program. I understand that through the Educational Talent Search Program my son/daughter will receive individualized and group tutoring, academic and career counseling, college preparation and orientation, and academic enrichment and cultural awareness sessions. Students will receive presentations and workshops to motivate them to continue their education and enroll in college upon high school graduation.

My signature on this document indicates that Educational Talent Search has my authorization to:
1. Grant my child’s corresponding school, permission to release any/all grades, transcripts, test reports and other academic information requested by the personnel of the Educational Talent Search Program.
2. Obtain release of confidential information, (i.e. financial, medical, welfare status, tests, academic school grades, and questionnaires for project evaluation purposes).
3. Make referrals to other agencies for specific services, (i.e. health, public assistance and psychological or career assessment).
4. Transport my child to college visitations, Saturday sessions, summer program activities, various field trips and other Educational Talent Search events or activities.
5. Photograph or videotape my child during Educational Talent Search events for the purpose of publication (i.e.: news release, televised reports, or news letter) in order to promote and enhance program activities.
6. Provide medical or surgical treatment from an available Hospital or by any Medical personnel in the event of an illness, accident, or emergency.
I further state that I will not hold my child’s school, Educational Talent Search and UTRGV (and staff), Edcouch-Elsa ISD (and staff), Mission CISD (and staff), and La Joya ISD (and staff) or any other authorized worksite organization or agency responsible or liable for medical and/or surgical treatment in such case of illness, accident or emergency situation or for any other accident, injury or misfortune which may occur to my child.

I also agree to assist in my son’s/daughters educational goals by promising to encourage consistent attendance and participation in the ETS program activities. If there is a concern with our child’s attitude or behavior and/or if there is a change in address or home telephone number, we will contact the ETS office at (956) 665-7590. Monitor my child’s involvement in homework assignments and study habits at home along with encouraging discussions on future academic plans. Support ETS policy, which states that any student who is having difficulties with a subject attend tutoring provided by the school or program until grades our satisfactory. I understand that the ETS program will provide parent meetings regarding information for my child’s academic future and/or opportunities and that I will make every effort to attend the corresponding meetings annually.

Medical Release Statement

I understand that in the event of an emergency, the Educational Talent Search Program will make every attempt to contact me. I authorize my child to receive medical care as deemed appropriate by competent medical personnel, and will take full responsibility for all costs incurred for my child’s medical treatment.
Student's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
The University of Texas Rio Grande Valley does not discriminate on the basis of race color, national origin, sex, age, veteran status or disability.

The Educational Talent Search Program is funded by U.S. Department of Education $502,050.00.

Emergency Medical Information
Educational Talent Search
Emergency Medical Information
Participant Name*

First NameLast Name
Parent/Guardian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home #*
(999)999-9999
Work #*
(999)999-9999
Cell #*
(999)999-9999

In case of an emergency*

	Name	Relationship	Telephone No
Emergency Contact 1
Emergency Contact 2

Name of Physician*

First NameLast Name
Office #*
(999)999-9999
List Medical Conditions*
List Allergies*
Medications, if any (OTC included)*
Insurance*
Policy #*
Policy Holder*
If there is a change in Doctor, home phone or address, please notify Educational Talent Search Staff at (956) 665-7590.
Participant Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
The University of Texas Rio Grande Valley does not discriminate on the basis of race color, national origin, sex, age, veteran status or disability.

The Educational Talent Search Program is funded by U.S. Department of Education $502,050.00.

Talent Search Edinburg Student Participant Application