Texarkana College-TS-Application Form

TEXARKANA COLLEGE TALENT SEARCH PROGRAM APPLICATION
The Texarkana College Talent Search is a federally funded TRIO program and all services are provided to program participants FREE OF CHARGE. The program provides academic, career, and financial counseling to program participants and encourages them to graduate from high school and continue to and complete their postsecondary education. This is an outreach program of the U.S. Department of Education and Texarkana College.
Texarkana College

2500 N Robison Road

Texarkana, TX 75599

903-823-3391
STUDENT NAME:*

First NameLast Name
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number:*
(999)999-9999
Alternate Phone Number:*
(999)999-9999
Email address:*
example@example.com
Date of Birth:*

MonthDayYear
Date
Age:*
Gender:*
STUDENT’S SOCIAL SECURITY NUMBER:*
999-99-9999
(This is required by the Department of Education and will be kept confidential.)
Students who apply to become part of the TRIO Talent Search program must be a U.S. citizen, national, or permanent resident as defined below. Please check your student’s status.*

U.S. CitizenU.S. National (includes natives of American Samoa or Swain’s Island)Permanent Resident (I-151, I-551, or I-551C status)Eligible Non-Citizen (Arrival-Departure Record (I-94) from U.S. Immigration and Naturalization Service)
Holders of student visas (F1, F2, J1, and J2 Visas) are not eligible.
Are you Hispanic or Latino?*

YesNo
Race

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhiteTwo or More
Please select*

I filed federal tax incomeI declare that no federal income tax was filed for the last tax period because my family’s gross income was insufficient to require filing.
Total number of family members living in the home:*
Student’s Educational Background and Need for Services
TRIO Talent Search offers the following services. Please check the services that you feel your student needs.*

Goal SettingAcademic Advising (high school & college)Study Skills AssistanceCareer ExplorationTutoringCollege application and admission assistanceCollege entrance exam prep (ACT, SAT, TSIA2)FAFSA and other scholarship application assistanceVisits to college campuses
School Attending*
Grade:*
Is your student currently active in another federally funded program?*

YesNo
Which of the following federally funded programs is your student currently active?*

Upward BoundUpward Bound Math/ScienceGEAR UpOther
Parent/Guardian Contact Information:
Name:*

First NameLast Name
Phone:*
(999)999-9999
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents email address:*
example@example.com
The Texarkana College Talent Search program is fully funded through a grant from the U.S. Department of Education and all services provided are completely free to the student and family. This document authorizes the release of academic records to TC Talent Search.

I certify that all of the above information is correct. Also, I give permission for Talent Search staff to receive an official copy of my student’s High School or Middle School transcript to Texarkana College Talent Search, Texarkana College, 2500 North Robison Road, Texarkana, Texas 75599
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Would you and your student like to receive Talent Search program updates and information via text message?*

YesNo
Parents Educational Background
The following questions are asked to determine first-generation college status of the student.
Highest level of education completed by student’s mother:*

Elementary grades 1-6Secondary grades 7-12Some college but no degreeAssociate DegreeBachelor's degree or higher
Highest level of education completed by student’s father:*

Elementary grades 1-6Secondary grades 7-12Some college but no degreeAssociate DegreeBachelor's degree or higher
Parents Income Information
The following information is used to determine income eligibility for the Talent Search program:
Please check the range of last year’s taxable family income (found on Line 15 of Form 1040)*

I declare that no federal income tax return was filed for the last tax period because my family’s gross income was insufficient to require filing$0 – $23,940$23,941 – $32,460$32,461 – $40,980$40,981 – $49,500$49,501 – $58,020$58,021 – $66,540$66,541 – $75,060$75,061 – $83,580If over $83,580, please specify amount
Including yourself, how many people live in your home?*

1 person2 people3 people4 people5 people6 people7 peopleIf over 8 people in the household, please specify how many
If over 8 people in the household, please specify how many
Please list the name, grade, and school of anyone else you would recommend for the Talent Search program:
Prospective Talent Search Participants
Please list the names and grades of any of your other children who may now or in the future benefit from joining the Educational Talent Search Program:
Authorization
The Texarkana College Talent Search program is fully funded through a grant from the U.S. Department of Education and all services provided are completely free to the student and family. This document authorizes the release of academic records to TC Talent Search.

I certify that all of the above information is correct. Also, I give permission to send an official copy of my student’s High School or Middle School transcript to Texarkana College Talent Search, Texarkana College, 2500 North Robison Road, Texarkana, Texas 75599

I understand that Talent Search normally takes photographs, video and/or tape recording of our events. During activities, a photograph or video/audio recording may be taken of you or your child. By signing below, I give permission for Talent Search to use my child's picture, art, written work, voice, image, verbal statements in any medium now known or developed in the future without any restrictions for use in any promotional or education purposes.
Parent/Legal Guardian Signature*

Clear
Date*

MonthDayYear
Date
Student Signature*

Clear
Date*

MonthDayYear
Date
STUDENT INFORMATION
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number if applicable:*
(999)999-9999
Birth Date:*

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

Hispanic/LatinoWhiteBlack/African AmericanHawaiian/Pacific IslanderAmerican Indian/Alaska NativeTwo or more
Are you currently active in another federally funded program?*

YesNoUpward BoundUpward Bound Math/ScienceGEAR UpOther
The Texarkana College Talent Search program is fully funded through a grant from the U.S. Department of Education and all services provided are completely free to the student and family. This document authorizes the release of your academic records to TC Talent Search at the age of 18 (eighteen).
Name of School attending:*
Student’s Social Security Number:*
999-99-9999
Student’s signature:*

Clear

TEXARKANA COLLEGE TALENT SEARCH PROGRAM APPLICATION

Student’s Educational Background and Need for Services

Parent/Guardian Contact Information:

Parents Educational Background

Parents Income Information

Prospective Talent Search Participants

Authorization

STUDENT INFORMATION