Eastern New Mexico University-Roswell-TS-Application Form

Student Outreach Programs • Educational Talent Search • College Preparatory Program
Si desea ver el formulario en español, cambie el idioma en la esquina superior derecha.
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone: *
(999)999-9999
Check one:

Cell PhoneHomeWork
Telephone Options:

ParentStudent
Telephone:
(999)999-9999
Check one:

Cell PhoneHomeWork
Telephone Options:

ParentStudent
Social Security #:
999-99-9999
Date of Birth:*

MonthDayYear
mm-dd-yyyy
Age:*
Gender:*

MaleFemaleDecline to AnswerOther
School Attending:*
Grade:*
Student ID #:
Where will you be attending High School?
Expected Graduation Date:

MonthDayYear
mm-dd-yyyy
Parent (1) Name:*

First NameLast Name
Parent (2) Name: *

First NameLast Name
Parent/Guardian living with:*
Parent(s)/Guardian(s) educational level:
Father, HS graduate?*

YN
Mother, HS graduate?*

YN
Bachelor’s Degree (4 yr.)? Father*

YN
Bachelor’s Degree (4 yr.)? Mother*

YN
Student US Citizen?*

YN
If no, are you a legal resident?

YN
Card Number:
Taxable income*
Number of people in household:*
Are your parents/guardians: Married?*

YN
Are your parents/guardians: Divorced?

YN
Are your parents/guardians: Separated?

YN
Are your parents/guardians: Never Married?*

YN
Ethnicity:*

HispanicWhiteBlackAmerican IndianAsianOther
Are you enrolled in any of the following: Honor/ AP classes?
Are you enrolled in any of the following: Concurrent/ Dual enrollment college courses?
Does your family receive any of the following?

Supplemental Security Income (SSI)Supplemental Nutrition Assistance Program (SNAP, EBT/Foodstamps)Temp. Assistance for Needy Families (TANF)Free/Reduced Priced LunchMedicaid
What have you thought about doing after high school graduation? Is there a particular career or college you are interested in?*
What is your Grade Point Average (GPA)?
Student E-mail Address:*
example@example.com
Parent E-mail Address:
example@example.com
I would like information and/or assistance in the following areas:*

Tutoring/Study SkillsACT/SAT PreparationCollege Information/AdmissionsCareer InformationFinancial Aid/ScholarshipsOther
I certify that the information in this application is true, complete, and correct to the best of my knowledge. All information contained here is strictly confidential and is used for reporting purposes only for the U.S. Department of Education. I give permission to release information pertaining to my academic school records.
Student’s Signature:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent’s Signature:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
PERMISSION FORM

Dear Parent/Guardian:

Your student has applied to Educational Talent Search, a program provided to local schools free of charge by the U. S Department of Education. Our counselors provide academic, career, and college counseling to each student participant. These services begin in the sixth through the twelfth grade, often with peer tutoring programs. As the students enter high school, they may take advantage of help with college entrance exams, admissions, financial aid, and scholarship location.

Our goals are:

1. To improve study skills

2. To increase their chances for high school completion

3. To assist them in continuing their education beyond high school

As mentioned above, this program is provided free of charge. However, a student must meet an income criterion, and/or be part of the first generation in your household to qualify for ETS and possibly qualify for financial aid. In order for him/her to apply to Educational Talent Search, the U.S. Department of Education requires answers to the following questions:
Student’s full name*

First NameLast Name
Number of people in household *
Yearly income (Taxable Income)*
Have one or both parents/guardians received a four-year college degree?*

YN
If yes, who?
Because lots of students do not know or remember their social security number, we ask the parent/guardian to please provide this information
Social Security #:
999-99-9999
I certify that the information contained in this application is true, complete, and correct to the best of my knowledge. I authorize the release of any official school records to Educational Talent Search. I understand they will only be used in planning educational goals and fulfilling federal income verification, and will be kept in strict confidence.

I, the undersigned, do hereby release all rights or claims in connection with the photo(s)/videotape in which I/my child (parent or guardian will sign for those students under the age of 18) appear, for use by Eastern New Mexico University-Roswell and I waive any right to inspect or approve the finished photos and/or advertising copy. All photographs, negatives and videotapes shall constitute the sole property of ENMU-Roswell. I declare that I am of legal age and have every right to contract in my own name in the above regard.
Initials*
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
School *
Grade*
We would like to keep you informed and involved with your child’s participation in this program. Please feel free to call with comments, questions, or ideas. We will be having parent meetings during the year, and I can arrange home visits if needed. I look forward to meeting with you and to watching your child progress over the years.

*Please have your child return this form to his/her counselor or mail to:

Trio- Educational Talent Search
ENMU-R Student Outreach
P. O. Box 6000
Roswell, NM 88202-6000
Feel free to call
(575) 624-72

Student Outreach Programs • Educational Talent Search • College Preparatory Program