Wytheville Community College-TS-Application Form

Wytheville Community College Talent Search

2024 – 2025 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 NameMiddle 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
7. Gender*

FemaleMale
8. Ethnic Background*

Hispanic/Latino of any raceWhite, non-Hispanic/LatinoAmerican Indian or Alaskan Native, non-Hispanic/LatinoNative Hawaiian or Other Pacific Islander, non-Hispanic/LatinoAsian, non-Hispanic/LatinoBlack or African American, non-Hispanic/LatinoTwo or more races, non-Hispanic/LatinoRace or Ethnicity Unknown
9. Is the student a U.S. Citizen? All students regardless of citizenship are eligible.*

YesNo
If not a U.S. Citizen, please answer the following question:
Is the student a permanent resident?

YesNo
Permanent Resident Alien Number
10. School attending during the 2024 – 2025 academic year:*
If your school was not listed above, please type it here:
11. Grade during the 2024 - 2025 school year: *
12. Is student in Upward Bound?*

YesNo
13. Please answer a & b in reference to parent’s (including adoptive) education but NOT guardians/stepparents. Answer c and d about the person(s) the student lives with.
a. Mother has earned a 4-year college degree?*

YesNo
If yes, where?*
b. Father has earned a 4-year college degree?*

YesNo
If yes, where?*
c. Full name of parent/guardian student lives with:*
d. Relationship to student:*
INCOME VERIFICATION
1. 2023 Income: THIS INFORMATION MUST BE COMPLETED OR THE APPLICATION CANNOT BE PROCESSED

Please complete questions 1 & 2 as they apply to your household
Did you file taxes in 2023?*

YesNo
If yes, you did file taxes for 2024, please check your household taxable income range for 2024 (Tax Form 1040 – Line 15).*

$23,475 or less$23,476 - $31,725$31,726 - $39,975$39,976 - $48,225$48,226 - $56,475$56,476 - $64,725$64,726 - $72,975$72,976 - $81,225$81,226 or more
How many people are in the household?*
2. Check all of the following sources of support that you received in 2023:*

Reduced Lunch at SchoolVeteran’s BenefitsSocial SecurityUnemployment CompensationFood Stamps/SNAPAid to Families with Dependent Children (AFDC)TANF (Temporary Assistance for Needy Families)NoneOther
ASSESSMENT & DETERMINATION OF STUDENT NEED FOR SERVICES
Does your child plan to go to college?*

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

	Career
1
2
3

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

	College
1
2
3

Which services does your child need in order to prepare for college? Please check all that apply.
❖ General College Information

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
❖ Financial Aid Information

How to pay for a college educationWhat are the differences between educational loans, grants and scholarships
❖ Tutorial Assistance

Assistance in identifying tutoring resources
❖ Career Awareness Assistance & Information

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
❖ Opportunities to Explore Colleges, Universities & Trade Schools

Interested in understanding the different opportunities available 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 program 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 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*
REQUIRED SIGNATURES
Student Signature: *

Clear
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

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