Delaware Technical & Community-George-TS-2023 Application Form

Name

First NameMiddle InitialLast Name

Student ID Number

Gender

Needs Assessment

Email

example@example.com

Student’s Social Security Number

999-99-9999

Date of Birth

mm-dd-yyyy

Sex

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Grade

School You Attend

Student Cell Phone Number

(999)999-9999

Student Home Access Log-In Username:

Student Home Access Log-In Password:

Ethnicity/ Race

Ethnicity: Is the student ethnicity Hispanic/Latino (Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin)

Race:

Please answer each of the following questions:

Is the student a U.S. citizen or a permanent resident?

If the student is a permanent resident, what is the alien registration number?

Is English the first/primary language of the students?

If not, what other language?

Student was referred by

Disclosure Statement: Educational Talent Search is required by the U.S. Department of Education to obtain participants’ educational backgrounds and household income level. This information is required of all participants and may need to be verified in order for students to qualify for participation. Additionally, this is the same information required if the student expects to receive any federal financial aid. EDUCATIONAL TALENT SEARCH ENSURES THAT ALL INFORMATION PROVIDED WILL BE HELD IN CONFIDENCE.

With whom does the student live?

Is the student a ward of the court (foster care)?

Name of parent(s)/Legal Guardian(s) with whom student lives

First NameLast Name

Parent Guardian: Phone Number

(999)999-9999

Parent/Guardian Email(s)

example@example.com

Please indicate the highest educational level completed by birth or adoptive parents with who the student resides:

Birth or Adoptive Mother

Does the Birth or Adoptive Mother have a degree from a 4-year college check box)

If yes, name of college

Degree

Birth or Adoptive Father

Does the Birth or Adoptive Father have a degree from a 4-year college check box)

If yes, name of college

Degree

Does the student receive free or reduced lunch or attend a school that is participating in the Community Eligibility Provision (i.e. all students receive free breakfast/lunch)

*To document the participant's low-income status, the Department of Education requires verification of family income from a government source. Please upload a copy of your filed 2024 Federal Income Tax Return.

Teacher Recommendation Name

First NameLast Name

Teacher Recommendation Email

example@example.com

Counselor Recommendation Name

First NameLast Name

Counselor Recommendation Email

example@example.com

Please indicate the 2022 taxable income which is the exact number that appears on Line 15.

Filing status of the person claiming the student:

Total number of dependents listed

My signature below indicates that, to the best of my knowledge, the information given on this application is true, complete and accurate. I hereby authorize Educational Talent Search to obtain copies of any of my child’s records (i.e. report cards, college enrollment status, etc.) from educational institutions my child presently attends or from educational institutions attended in the future.

Parent Signature

Date

mm-dd-yyyy

Please write a brief statement indicating why you want to participate in the Educational Talent Search program. You may also include what you expect to gain from your participation in the program.

Activities/Clubs you presently participate in: In school (i.e. National Honor Society, Foreign Language Club, BPA, FFA, Educators Rising, HOSA, sports, etc) and out of school activities (i.e.Boy Scouts, Girl Scouts, 4-H, Church Youth Groups, community sports teams etc)

Student Signature

Date

mm-dd-yyyy

The mission of the Educational Talent Search program is to partner with students, families, and the community to ensure each student acquires the education and skills necessary to achieve their educational, vocational, and personal goals to become globally competitive in the workforce.

*** If you require specialized accommodations based upon disability, please bring this to the attention of the Program Manager who will work with the appropriate personnel to address individual needs. **

This material is the sole property of Delaware Technical Community College. General use, duplication and reproduction are prohibited without written permission.

Educational Talent Search Application

Part 1: Student Information

PART II. Parent/Guardian Information

PART III

PART IV-Student Personal Statement