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

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

BHS 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?*

YesNo

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

If opting out of photo release, please check previous box.

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