Eastern Kentucky University-TS-2024 Application Form

2025-2026 EKU Educational Talent Search Program Application Form

Educational Talent Search is funded by United States Department of Education and sponsored by Eastern Kentucky University. The program works with 6th-12th grade students within the target area (Estill, Garrard, Jackson, Lee, and Madison counties) schools to provide academic and personal support, college and career readiness, financial guidance, and post-secondary/financial aid application and transition assistance. All information obtained in this application is confidential to EKU, Department of Educational Talent Search Staff. All applicants are selected without regard to race, color, national origin, gender, age, or disability. ALL SERVICES ARE FREE; MOST SERVICES ARE PROVIDED AT THE SCHOOL, DURING THE SCHOOL DAY! If you have questions, please contact the program Director, Andrea Brin at 859-622-5822.
- 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 09/01/2025 student attends
- As of 09/01/2025 student attends*
- As of 09/01/2025 student will be/is in what grade?
- As of 09/01/2025 student will be/is in what grade?*
- How did you learn about Educational Talent Search?
- Is the Student a U.S. Citizen, National, Permanent Resident or in process of U.S. Citizenship?*
  
  YesNo
- Race/Ethnicity information is optional. The information you provide is for statistical purposes only; mark all that apply.
  
  American Indian or Alaska NativeAsianBlack or African AmericanCaucasian/WhiteHispanic/LatinoNative Hawaiian or Other Pacific IslanderOther
- Does the student have the interest and ability to continue education beyond high school?*
  
  YesNo
- Is the student an honor roll student with mostly As and Bs and maybe a C or two?
  
  YesNo
- Is the student currently participating in any other college preparation programs such as Gear Up, Upward Bound, or Upward Bound Math/Science?*
  
  YesNo
- If yes, please list the program
- What do you plan to do after you graduate from high school?
- What career(s) or subject area is the student interested in?
- Please check which services/activities the student feels would help them the most as they prepare for college (please select at least one). *
  
  Academic AdvisingCareer Guidance & ExplorationCharacter DevelopmentCollege Admissions AssistanceCollege Exam PreparationCollege VisitsCommunication SkillsConflict ResolutionCultural Awareness & DiversityDecision MakingFinance/Money ManagementFinancial Aid Application AssistanceLeadership DevelopmentScholarship ApplicationsStudy SkillsTutoring
- Other Middle/High School Age Students in the Household (Name, School and Grade)
- The Educational Talent Search program is funded to serve approximately 70% of students who meet the eligibility criteria of low-income, first-generation potential college student status; meaning neither parent has a four-year college degree. In meeting this federal regulation, we ask that you provide the following information used to determine eligibility. The information you provide is strictly confidential and used solely to determine program eligibility.
- Student lives with
  
  2 Birth or Adoptive Parents1 Birth or Adoptive ParentBirth and StepparentCourt Appointed Guardian(s)Other
- Are both biological parents living?
  
  YesNo
- Are either biological parents incarcerated?
  
  YesNo
- Does the student have a parent/guardian currently serving in the military?
  
  YesNo
- Does the student have a parent/guardian who is a military veteran?
  
  YesNo
- Parent/Guardian #1
  
  ParentGuardian
- Full Name: *
  
  First NameLast Name
- Phone*
  (999)999-9999
- Email:
  example@example.com
- Occupation: *
- College Attended (if any):
- Would you like information on furthering your education and financial aid programs?
  
  YesNo
- Highest Level of Education:*
  
  Did not complete High SchoolGEDHigh School DiplomaCertificateAssociatesBachelorsMastersDoctorate
- Parent/Guardian #2
  
  ParentGuardian
- Full Name:
  
  First NameLast Name
- Phone
  (999)999-9999
- Email:
  example@example.com
- Occupation:
- College Attended (if any):
- Would you like information on furthering your education and financial aid programs?
  
  YesNo
- Highest Level of Education:
  
  Did not complete High SchoolGEDHigh School DiplomaCertificateAssociatesBachelorsMastersDoctorate
- Total number living in the household: *
- Sources of Income – Check all that apply.
  
  EmploymentUnemploymentFree School LunchSNAPChild SupportWICDisability IncomeTANFSocial SecuritySurvivor BenefitsRetirementVeterans BenefitsOther
- INCOME VERIFICATION Federal Regulations require verification of family income must be submitted as part of the application process. Using your IRS Tax Form 1040 line 15, please mark your Household Taxable Income Range below, please note, this is NOT your Gross Income:*
  
  1. $0 to $23,9402. $23,941 to $32,4603. $32,461 to $40,9804. $40,981 to $49,5005. $49,501 to $58,0206. $58,021 to $66,5407. $66,541 to $75,0608. $75,061 to $81,2259. Above $83,580
- The information provided within this application, including citizenship, grade level, the eligibility criteria (degree attainment level of birth parent(s) or adoptive parent(s) in which the student lives and income verification), is accurate to the best of my knowledge as of the date in which I have submitted this application.
- Signature
  
  Clear
- 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
- Permission to Participate*
  
  Yes, I grant permission for my student to participate in ETS, and my student agrees to meet with ETS Staff at the school for meetings and workshops, designed to support the student academically and to assist them in their transition throughout secondary school onward to post-secondary enrollment and completement.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.
- Permission to release Educational Records to the EKU Educational Talent Search Program*
  
  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
- Student's Name
  
  First NameLast Name
- Infinite Campus Portal Access: I authorize the EKU ETS staff for access to my child/students' Infinite Campus Portal to access schedules, missing assignments, grade reports, transcripts, behavior reports, attendance report, etc.
  
  Yes, I grant permission for Infinite Campus Portal AccessNo, I do not grant permission for Infinite Campus Portal Access
- 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.
- Student Name*
  
  First NameLast Name
- Permission of Media Release*
  
  Yes. I grant permission for media releases.No. I do not grant permission for media releases.
- Parent/Guardian Signature*
  
  Clear
- Date*
  
  MonthDayYear
  Date

2025-2026 EKU Educational Talent Search Program Application Form