Eastern Kentucky University-TS-2024 Application Form

Educational Talent Search Application

6th – 12th Grade students in Estill, Garrard, Jackson, Lee, and Madison Counties Eastern Kentucky University Telford House – Eastern Kentucky University 521 Lancaster Ave., Richmond, KY 40475 Educational Talent Search, a TRIO Program, is funded by the U.S. Department of Education

Student Information
Student’s Name *

First NameMiddle InitialLast Name
Preferred Name
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Cell Phone
(999)999-9999
Student Email*
example@example.com
Sex

MaleFemale
Date of Birth*

MonthDayYear
Date
Age
As of 09/01/2024 student attends
As of 09/01/2024 student will be/is in what grade?
Is the Student a U.S. Citizen, National, Permanent Resident or in process of U.S. Citizenship?*

YesNo

AUTHORIZATIONS/RELEASES
Parent's Name

First NameLast Name
Student's Name

First NameLast Name
This is a legal document. You must read and understand it before signing it.

PERMISSION TO PARTICIPATE: I give permission for my child/student to participate in the EKU Educational Talent Search Program at Eastern Kentucky University. I, the undersigned, confirm that all the information on this application is true to the best of my knowledge and feel that my child/student has shown potential for success in a postsecondary education program. My child/student has my support in this endeavor as they strive to be engaged in achieving success through ETS
Permissions

Yes, I grant permission for my student to participate in ETS.No, I do not grant permission for my student to participate in ETS.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Student's Name

First NameLast Name
EDUCATIONAL RECORDS RELEASE: Records will be used to assess student needs, monitor progress, document eligibility, and for reporting purposes. This information is confidential and protected under the General Education Provision Act. I hereby grant permission for the Educational Talent Search program at Eastern Kentucky University to have access to the educational records of my child/student, including (but not limited to) grades, test scores, free/reduced price lunch eligibility, class schedules, attendance, behavior, medical, court orders, and postsecondary enrollment status for the duration of the student’s enrollment in the EKU Educational Talent Search Program. I understand the Educational Records Release can be revoked at any time and ETS will not release any confidential information without my written consent.
Permissions

Yes, I grant permission for Educational Records Release.No, I do not grant permission for Educational Records Release.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
MEDIA RELEASE: I grant the Educational Talent Search Program at Eastern Kentucky University, and persons acting through them, the right to use, reproduce, assign, and/or distribute photographs, films, videotapes, and sound recordings of my minor child/student without compensation for use in promotion/advertising, educational publications, electronic publishing, and personal memorabilia. Participant names may be published.
Permissions

Yes. I grant permission for media releases.No. I do not grant permission for media releases.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Educational Talent Search Application