Purdue University-Northwest-TS-High School Application
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  • Purdue University Northwest - Hammond TRIO: Educational Talent Search Participant Application (Grades 9-12)

  • CLO Bldg., Room 176, 2200 169th Street, Hammond, IN 46323-2094
    Phone: 219-989-2460 Fax: (219) 989-2094
    Website: http://www.pnw.edu/ets/

    • Student Information 
    • 5. Date of Birth:*
       - -
    • Gender:*
    • Grade Level:*
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    • 7. Ethnicity (Check all that apply):*
    • 8. Are you currently participating in the Upward Bound Program or any other Federal TRIO or GEAR UP Program?*

    • As required by the US Department of Education, please complete the following questions in order to be considered for the Educational Talent Search Program at Purdue University Northwest- Hammond.

    • 9. Are you a U.S.A. citizen?*
    • If not, are you a Permanent Resident of U.S.A?*
    • 10. Please check the statement that best describes the parents/guardians Veteran’s status:*
    • Family Information 
    • Father has a 4-year college degree?*
    • Mother has a 4-year college degree?*
    • Rows
    • Income Information 
    • 2. Did your family participate or receive any of the following (Please check all that apply)*
    • Authorization and Release 

    • The personal information that you give to the Educational Talent Search Program (ETS) is for the U.S. Dept. of Education. This information is protected by the Privacy Act. No one may see the information unless he/she work with or for the Educational Talent Search Program or are specifically authorized to see it. The information is necessary to determine if your child is eligible to participate in the Educational Talent Search Program and helps the U.S. Dept. of Education to measure his/her success. The U.S. Dept. of Education has the authority to gather such information (20 USC 1231a). Your child is not eligible for any services from the Educational Talent Search Program unless the information is given.

      • I/we certify that all the information provided on this application is true and correct.
      • I/we authorize my child’s school to release records (transcripts, standardized test scores, free and reduced lunch eligibility, class schedule, and attendance record) to the ETS Program at Purdue University Northwest- Hammond.
      • I/we authorize ETS representatives to communicate with post-secondary institutions on my child’s behalf for up to six years post high school graduation. This authorizes the release of post-secondary records (admission, enrollment, and financial aid information) to the ETS program.
      • I/we authorize the release and exchange of my child’s financial aid information from colleges and federal government to ETS.
      • I/we understand that the completion of this application does not guarantee acceptance into the ETS program.
      • I/we authorize the use of my child’s image in ETS publications and media releases to the ETS program.
    • Clear
    • Date*
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    • Clear
    • Date*
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    • ALL SECTIONS OF THIS APPLICATION MUST BE COMPLETED TO BE CONSIDERED FOR THE ETS PROGRAM.

    • A Completed Application Includes:*
    • Purdue University Northwest - Educational Talent Search Individual Education Plan (Needs Assessment) 

    • Purdue University Northwest - Educational Talent Search Individual Education Plan (Needs Assessment)

    • Grant Period - 2024

    • Rows

    • I request these services from Educational Talent Search and agree to cooperate in order to obtain them.

    • Clear
    • Date*
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    • Submit 
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