Mountain Gateway Community College-TS-Application Form

a. Student’s name:

First NameMiddle InitialLast Name

b. Student’s mailing address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

c. Student's phone number:

(999)999-9999

d. Student's email:

example@example.com

e. Parent/Legal guardian's phone number:

(999)999-9999

f. Parent/Legal guardian's email:

example@example.com

g. School name:

h. Grade level:

i. Student’s social security number:

999-99-9999

j. Student’s date of birth:

mm-dd-yyyy

k. Student’s gender:

l. Student’s ethnicity:

m. Is the student a U.S. citizen?

*If you answered YES to the previous question, please go to STEP 2. If you answered NO, please answer the question below.

If the student is NOT a U.S. citizen, is he/she a permanent resident?

a. Did the student’s father graduate from college with a 4-year degree (bachelor’s)?

b. Did the student’s mother graduate from college with a 4-year degree (bachelor’s)?

c. Select the number of people who reside in your household (including the student):

d. List the members of your household below, starting with the student.

Rows	First and Last Name	Age	Relationship to Student	Place of Employment or Grade in School
1
2
3
4
5
6
7
8

a. Is the student married?

b. Does the student have children or other dependents (other than a spouse) who receive more than half of their support from the student?

c. Is the student an orphan, in foster care, or a ward of the court?

d. Is the student an emancipated minor or does he/she have a court-appointed legal guardian?

e. Is the student less than 18 years of age and has no parent or guardian?

f. Is the student homeless or at risk of becoming homeless (i.e. he/she lacks a fixed, regular, and adequate nighttime residence)?

What is your household’s Annual Taxable Income* for the previous year?

*Annual Taxable Income is usually lower than Adjustable Gross Income. It is located at the bottom of the first page of most tax forms.

a. Does the student plan to complete the requirements to graduate with an Advanced Studies diploma?

b. Does the student plan to go to a college, university, or technical school after completing high school?

c. What Talent Search services does the student need in order to prepare for post-secondary opportunities? Check all that apply.

By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the student’s official academic records and grades to MGCC Educational Talent Search, understanding that the information in these records will be used only to assess the student’s need for program services, discern the student’s academic progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements. My signature also gives permission to publish my student’s name and/or photographs of my student for TS promotional materials, including online posts (social media, etc.). Additionally, my signature grants permission for my student to participate in online platforms/services (i.e. Brainfuse, Pathful Explore, Zoom, etc.) offered by the Talent Search program where my student’s participation is voluntary, and I take responsibility for his/her participation in those platforms/services. I understand that all personal information will be held in the strictest confidence.

Student Name

First NameLast Name

Student's Signature

Date

mm-dd-yyyy

Parent/Legal Guardian's Name

First NameLast Name

Parent/Legal Guardian's Signature

Date

mm-dd-yyyy

* The Talent Search Project of Mountain Gateway Community College is 100% funded by the U.S. Department of Education. Please note that all applications are accepted for review regardless of race, color, national origin, religion, gender, or disability.

Educational Talent Search Application

STEP 1: Please answer the following questions about the STUDENT unless stated otherwise.

STEP 2: Please answer the following questions about the student’s parents and household.

STEP 3: Please answer the following questions about the STUDENT. Select ‘YES’ or ‘NO’ for each question.

STEP 4: If the student answered ‘YES’ to any of the questions in STEP 3, the student must answer the following questions about himself/herself. If the student answered ‘NO’ to all of the questions in STEP 3, a parent must answer the following questions about himself/herself.

STEP 5: Please answer the following questions about the STUDENT.

Please read the following statement and sign and date below it. If the student answered ‘NO’ to all the questions in STEP 3, a parent or legal guardian must also read the following statement and sign and date it as well.