Wytheville Community College-TS-Rising 6th Application Form

Wytheville Community College Talent Search Rising 6th Grader 2025 - 2026 Application
Due to federal guidelines of this program, it is required that all participants and their parents and/or guardians complete the following information.

This information will be strictly confidential, secured in a locked file cabinet, and reported only in a numerical format.

THIS FORM MUST BE COMPLETED IN ORDER TO BE A TALENT SEARCH PARTICIPANT. PLEASE DO NOT LEAVE ANY QUESTION UNANSWERED.
1. Student’s Name*

First NameLast Name
2. Mailing Address (Street and/or P.O. Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
3. Home Phone
(999)999-9999
Alternate/Cell Phone
(999)999-9999
4. Parent Personal Email:
example@example.com
5. Student Personal Email:*
example@example.com
6. Date of Birth*

MonthDayYear
mm-dd-yyyy
FemaleMale
Hispanic/Latino of any raceAmerican Indian or Alaskan Native, non-Hispanic/LatinoAsian, non-Hispanic/LatinoBlack or African American, non-Hispanic/LatinoWhite, non-Hispanic/LatinoNative Hawaiian or Other Pacific Islander, non-Hispanic/LatinoTwo or more races, non-Hispanic/LatinoRace or Ethnicity Unknow
YesNo
YesNo
Permanent Resident Alien Number
10. What grade is the student in during the 2025-2026 academic year?*
What grade is the student in during the 2024-2025 academic year?
11. What school will the student be attending during the 2026-2027 academic year?*
If your school is not listed, please list it here:
YesNo
If yes, what institution?
YesNo
If yes, what institution?
12 C. Name(s) of the parent/guardian the student lives with:*
12 D. What is your relationship to the student? (parent, step-parent, adoptive parent, grandparent, guardian, etc.)*
INCOME VERIFICATION

Please complete questions 1, 2 & 3 as they apply to your household
1. 2024 Tax Information: THIS INFORMATION MUST BE COMPLETED OR THE APPLICATION CANNOT BE PROCESSED
Referring to your 2023 taxes, please enter the dollar amount listed on line 15 of the Tax Form 1040. $*
YesNo
If you did not file 2023 taxes, check this box.
How many people are in your household?*
$23,939 or less$23,940 - $32,459$32,460 - $40,979$40,980 - $49,499$49,500 - $58,019$58,020 - $66,539$66,540 - $75,059$75,060 - $83,579$83,580 or more
Free Lunch at SchoolAid to Families with Dependent Children (AFDC)Reduced Lunch at SchoolVeteran’s BenefitsSocial SecurityUnemployment CompensationFood Stamps/SNAPOther
ASSESSMENT & DETERMINATION OF STUDENT NEED FOR SERVICES
YesNoNot Sure
Note: "College" can mean a community college, university, or trade school

What three careers interest your child the most? Ex. Artist, Physician, Social Worker

Rows	Career
1
2
3

What are your child's top 3 colleges of interest?

Rows	College
1
2
3

Which services does your child need in order to prepare for college? (Please check all that apply)
My son/daughter is not sure of why they should go to collegeHow to get my child ready for educational opportunities beyond high schoolHaving my child understand the benefits of going to college and earning a degreeAssistance to better understand the process of preparing ourselves as a family for college
How to pay for a college educationWhat are the differences between educational loans, grants and scholarships
Assistance in identifying tutoring resources
Assistance with identifying what's really my child's interestExploring the different careers and what are the opportunities availableHaving my child meet people from different professional backgrounds
Interested in understanding the different opportunities at the collegesInterested in visiting colleges which offer what my child might like to studyLearning about the differences between college, universities, and trade school
CERTIFICATION ● RELEASE ● PERMISSION TO PARTICIPATE
I hereby certify that the household and financial information indicated above is accurate to the best of my knowledge. I hereby authorize the Wytheville Community College Talent Search project to obtain, as needed, the academic records of my son/daughter. The requested records include school transcripts, attendance records, and assessment test scores. I grant permission for the information to be used to assist in career planning, college searches, and the college admission process.
Parent/Guardian Please Initial:*
As part of the WCC Talent Search program, field trips are planned throughout the year. I understand that my child will have the opportunity to visit museums, educational facilities, career sites and participate in cultural events, and will be chaperoned by Talent Search staff.
Parent/Guardian Please Initial:*
I understand that the program will meet monthly at my child’s middle school. I will encourage my child’s attendance at these meetings and understand that failure to attend will result in being dropped from the program.
Parent/Guardian Please Initial:*
I understand that photographs will be taken during the year of students, and I authorize WCC Talent Search to utilize these in promotional materials if my child’s photo is taken, including online such as a website and Facebook.
Parent/Guardian Please Initial:*
My child has my permission to participate in the Wytheville Community College Talent Search Program.
Parent/Guardian Please Initial:*
Applicant’s Name:*

First NameLast Name
Parent/Guardian’s Signature:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
WCC Talent Search does not discriminate against students, or applicants on the basis of race, color, sex, handicap, age, national origin, religion, or political affiliation.

NOTICE: Any person falsifying information stated on this application may be considered in violation of federal laws.

Wytheville Community College Talent Search Rising 6th Grader 2025 - 2026 Application

INCOME VERIFICATION

ASSESSMENT & DETERMINATION OF STUDENT NEED FOR SERVICES

Which services does your child need in order to prepare for college? (Please check all that apply)

CERTIFICATION ● RELEASE ● PERMISSION TO PARTICIPATE