Broward College-ASPIRE-TS-Parent Form

Parent/Guardian 1:*

First NameLast Name

Cell Phone*

(999)999-9999

Email Address*

example@example.com

Parent Guardian 2:

First NameLast Name

Cell Phone

(999)999-9999

Email Address

example@example.com

Did either parent/guardian graduate from a 4-year college*

YesNo

If yes, which college?

Total number of people in your Household (including other children away in college)*

Below, please check the box with the amount of taxable income received by your household.
(Please note: Taxable income may be found on your most recent income tax return. Also, emancipated students and children in Foster Care please
check “$20,385 or below.”

Please select:*

Please note: The income ranges are based on income guidelines for Federal TRIO programs. Eligibility for Talent Search will be determined by income, as well as
number of people living in the household.

Parent/Guardian Information Endorsement & Consent
For Participation and Release of Records

Parent or Guardian Residing with child*

First NameLast Name

Child’s Name*

First NameLast Name

Email*

example@example.com

I, {main_name} grant my child permission to participate in activities of the Broward College Talent Search Program.

By signing this consent form, I promise to support the Talent Search Program’s efforts to help my child progress toward the goal of attending college/university or technical/vocational school.

Also, I give consent for:

· My child to participate in certain activities that require transportation provided by the program.

· I give permission for the release of my child’s grades, test scores, promotional/retention status, financial aid acceptance, post-secondary enrollment status and current contact information (i.e. address, telephone, etc.).

· (Optional. Please check if you agree) Permission for the Broward College Talent Search Program to use my child’s photograph in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Do you agree to the optional agreement above?

I agreeI do not agree

I will hold the TRIO Talent Search program and Broward College program harmless for any damages that might result from the activities and releases mentioned above.

This is to certify that all the information on this application is correct to the best of my knowledge.

SIGNATURE OF PARENT OR GUARDIAN RESIDING WITH CHILD

Date

mm-dd-yyyy

Signature of Student (If 18 years or older)

Date

mm-dd-yyyy

Check box for Student 18 years or older

I certify that I am 18 years old or older and I consent to the above statements.

ALL PARTICIPANT INFORMATION WILL BE HELD IN STRICT CONFIDENCE BY ALL TRIO TALENT SEARCH STAFF.

TRIO Talent Search is federally funded by the US Department of Education and administered by Broward College. Talent Search also works in conjunction with your local school guidance office and focuses on students in grades 6th – 12 grades. ALL SERVICES RENDERED BY THE PROGRAM ARE FREE. Applicants are selected without regard to race, color, creed, religion, national origin, gender or disability.

TRIO Talent Search is committed to guiding and inspiring students in pursuing their dreams toward postsecondary education.