Massasoit Community College-Brockton & Canton-TS-Application Form

Si desea ver el formulario en español, cambie el idioma en la esquina superior derecha.

Se pretender visualizar o formulário em inglês, altere o idioma no canto superior direito.

Si vous souhaitez consulter le formulaire en français, changez la langue dans le coin supérieur droit.

TRiO Talent Search is a FREE student support program designed to encourage Brockton High School students to graduate from high school and enroll in programs of post-secondary education. We ask the following questions because this program is federally funded/future funding depends on the population we serve. Please note that your answers will remain confidential. Without this completed form, your child will not receive these specialized services. Please fill-out and hit submit.

Today's Date

mm-dd-yyyy

Name

First NameMILast Name

BPS ID Number:

Current Grade:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Phone:

(999)999-9999

Student Email Address:

example@example.com

Date of Birth

mm-dd-yyyy

Are you a US Citizen?

If No, Alien Registration No.:

The next question about race/ethnicity is optional but answering them is helpful for Talent Search reporting purposes. Please check (√) all that apply:

Race/Ethnicity:

Your Family Size (include yourself):

Number of Family Members in College:

EDUCATIONAL STATUS (of Custodial Parents or Legal Guardians only)

Check highest educational level COMPLETED by Custodial Parent or Legal Guardian 1

Check Highest educational level COMPLETED by Custodial Parent or Legal Guardian 2 (if applicable)

If bachelor’s degree was completed:

Name of parent/guardian 1 college/country:

Name of parent/guardian 2 college/country:

Primary Income / Support Sources - pertaining to parents/guardian (or student if independent) Please check (√) only one:

Income Level: Check (√) the range of your family’s taxable income for the previous year.

Parent / Guardian / Release of Information: *I certify that the information is correct and understand that by signing this form, I give permission to Massasoit Community College TRiO Talent Search to obtain the academic records/information for the above named student throughout his/her high school career and for six years following his/her graduation to allow for annual tracking of TS participant’s education as is required by Federal Department of Education regulations to evaluate the TS Program. I give my student permission to participate in TRIO Talent search program and events. I also release images of the student to be used for program promotion.

If opting out of the photo release, please check here

I understand that this information will be held in complete confidence by the Talent Search Program administered by Massasoit Community College.

Parent/Guardian Name:

First NameLast Name

Parent or Guardian’s Signature:

Date

mm-dd-yyyy

Student Signature:

Date

mm-dd-yyyy

TRiO Talent Search at Brockton High School

Student Information

Family Information