Wahupa Educational Enterprises, Inc.-City-TS-Application Form

What school do you currently attend? *

If you selected Kearny Educational Complex, please select which school you are enrolled in: *

Name*

First NameMiddle InitialLast Name

Social Security Number: (Optional)

999-99-9999

Birthdate:*

Date

Gender:*

MaleFemale

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Grade:*

Student Cell:*

(999)999-9999

Parent Cell 1:*

(999)999-9999

Parent Cell 2:

(999)999-9999

Home Phone:

(999)999-9999

Student I.D. Number: *

Email 1:*

example@example.com

Email 2:

example@example.com

Are you currently in any college-prep program listed below: (If Yes, circle which one)*

ETS, YesEOC, YesUB, YesNo

Do you speak a language other than English at home?

YesNo

If yes, please specify

Career(s) you are interested in:

College(s) you would like to apply to:

Do you have any siblings at this school?

YesNo

Ethnicity Background: (mark all that apply)*

Are you Hispanic/Latino?*

YesNo

Residency / Citizenship:*

U.S. CitizenU.S. Permanent ResidentApplication pending for permanent residencyNone of the Above

I give my consent to Wahupa to secure and review information that may be needed to verify my income, to complete applications to postsecondary institutions and financial aid programs. I grant permission to the personnel of my student’s school to provide copies of transcripts, test scores, and academic progress reports to Wahupa during the application process and throughout the period of their participation in the program. I give permission for the use of my student’s name and photograph for editorial, promotional, recruitment and/or education purposes. The student authorizes Wahupa to access and the right to request/release collegiate admissions, enrollment and financial aid information and documents. I understand that all information will be held in the strictest of confidence and used for statistical and reporting (e.g., Dept. of Ed.) purposes only.

This information is correct to the best of my knowledge.

Signature of Student*

Today's Date*

Date

The following information is kept absolutely confidential under the regulations of the U.S. Department of Education and is used to establish eligibility for FREE services for college admissions and financial aid.

Name*

First NameLast Name

Relationship:*

MotherFatherStep-ParentLegal Guardian

Name

First NameLast Name

Relationship:

MotherFatherStep-ParentLegal Guardian

Did the natural or adoptive parent(s) who live with the student receive a bachelor's degree (graduate from a four-year university)?*

YesNo

If Yes, specify name of university

Number in household (include yourself, spouse and children):*

What was your household's total annual taxable income last year?*

Signature of Parent/Legal Guardian

Date

Wahupa Educational Talent Search City 2025 - 2026