Millersville University-TS-Application Form

What school are you attending?

What is your current grade

What is your date of birth

Date

What is your name?

First NameMiddle InitialLast Name

Preferred Name

What is your Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is your non-school e-mail address?

example@example.com

What is your best daytime telephone number?

(999)999-9999

Please select from the following that best describes your situation

Rows	Yes	No
A citizen or national of the United States
A permanent resident of the United States
In the United States for other than a temporary purpose and provides evidence from the Immigration and Naturalization service of his or her intent to become a permanent resident.
A permanent resident of Guam, the Northern Mariana Islands, or the Trust Territory of the Pacific Islands (Palau)
A resident of the Freely Associated States- The Federated States of Micronesia or the Republic of the Marshall Islands

Please select from the following that best describes your situation

Other

Are you Spanish, Hispanic, or Latino, or none of these? (Mark all that apply)

Choose one or more races that you consider yourself to be

What is your gender?

What Primary language spoken at home?

Other

Are you currently in a dual enrollment program?

Are you taking any rigorous enrollment courses? (select all that apply)

Do you participate in any of the following (check all that apply):

Name of Parent or Guardian

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone #

(999)999-9999

Cell Phone #

(999)999-9999

Highest Education Level

Highest education level this parent has completed:

Name of Parent or Guardian

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone #

(999)999-9999

Cell Phone #

(999)999-9999

Highest Education Level

Highest education level this parent has completed:

Who do you live with?

Are you currently in foster care?

If applicant is a foster child, please type "Foster Child" here

Educational Talent Search is required by federal law and the U.S. Department of Education to document family size and income for every participant. All information remains confidential. Thank you in advance for your assistance.

Did you file a tax return for the most recent tax year

Did your parent(s) or guardian(s) file a tax return for the most recent tax year

Does your household receive assistance from any of the following programs?

Other

How many people (including yourself) live in your household?

Please select the category that most accurately reflects your households taxable (not total or gross) income from last calendar year.

Release of Information Student Applicant

Please read and sign the Release of Information statement. ETS collects data on all participants as required by the U.S. Department of Education. such data helps us assist students and serves as a measure of program performance. All data collected is kept under the strictest confidence and is protected by the Privacy act.

My signature below indicates that, to the best of my knowledge, the information on this application is complete and accurate. I hereby authorize Millersville Talent Search to obtain copies of academic and financial assistance records from educational institutions that I am attending now or from educational institutions I will attend in the future and consent to the use of photos for promotional and educational purposes.

Student Acknowledgement:

As a participant of the Talent Search Program, I understand that I must maintain a 2.0 GPA, work with my counselor to apply to postsecondary institutions, schedule college prep classes, and apply for financial aid. If I fail to do any of these requirements, I may be dropped from the program.

Signature

Release of Information for Parent or Guardian

Please read and sign the Release of Information statement. ETS collects data on all participants as required by the U.S. Department of Education. Such data helps us assist students and serves as a measure of program performance. All data collected is kept under the strictest confidence and is protectedd by the Privacy Act.

My signature below indicates that, to the best of my knowledge, the information on this application is complete and accurate. I hereby authorize Millersville Talent Search to obtain copies of academic and financial assistance records from educational institutions that my student is attending now or from educational institutions that my student will attend in the future and consent to the use of photos for promotional and educational purposes.

Signature

MU Trio Application