Shawnee Community College-TS-2026 Application Form

TRIO - Educational Talent Search Shawnee Community College Application
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STUDENT INFORMATION:
Full Name:*

First NameLast Name
Preferred Name:
School:*
Grade:
Birthdate:*

MonthDayYear
mm-dd-yyyy
Age:*
Student Email:*
example@example.com
Gender:

FemaleMale
Mailing address: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone:
(999)999-9999
Cell phone:
(999)999-9999
Please select if applicable:

OK to send text messages
Are you Hispanic/Latino?

YesNo
Are you a US citizen?

YesNo
If you marked NO, are you a permanent resident?

YesNo
Please provide your permanent resident number:
Please select one or more options listed below:

American Indian or Alaska NativeAsianBlack or Native AmericanNative Hawaiian or Other Pacific IslanderWhiteTwo or more racesUnknown
NEEDS ASSESSMENT: Which needs can Talent Search help you with this year? (Check as many as apply):*

Information about colleges / universities / technical schoolsApplying for college admissionsFinancial aid application assistanceFinancial aid informationFinancial literacyCollege admissions informationSAT/ACT info/registrationScholarship information / searchCareer exploration / assessmentCollege transition informationChoosing a college majorStudy/test-taking skillsTime managementFee waiverCollege/career/cultural field tripsAcademic advisingCollege course registration assistanceGoal settingOnline tutoringCommunity service informationMentoringLeadership skillsPersonality assessment
If you are a high school student, what is your grade point average (gpa)?
If you are a high school student taking rigorous coursework, mark the type(s) of classes you are taking (mark all that apply):

Advanced Placement (AP)Honors coursesDual-credit coursesCollege prep coursesOther
If you are a middle school student, what kind of grades do you typically make in school?

Mostly A'sA's and B'sMostly B'sB's and C'sMostly C'sD's and lower
Are you currently a member of TRIO Upward Bound or Upward Bound Math & Science?

YesNo
FIRST GENERATION STATUS:
Does the student’s FATHER have a 4-year college degree?

YesNo
College:
Does the student’s MOTHER have a 4-year college degree?

YesNo
College:
PARENT / GUARDIAN INFORMATION:
Parent Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/ cell phone:
(999)999-9999
Please select if applicable:

OK to send text messages
Email address:
example@example.com
Relationship to student:
Circle the response that applies:

BIOLOGICALADOPTIVEOther
Does the student live with this parent?

YesNo
Parent Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/ cell phone:
(999)999-9999
Please select if applicable:

OK to send text messages
Email address:
example@example.com
Relationship to student:
Circle the response that applies:

BIOLOGICALADOPTIVEOther
Does the student live with this parent?

YesNo
INCOME ELIGIBILITY:

ALL QUESTIONS REQUIRED.
How many people are in your household?
Does the student/family qualify as homeless?

YesNo
Did you file a tax return in 2024?

YesNo
SECTION A: REQUIRED
Select the range that matches your taxable income, not your total income. You can find your taxable income on your most recent tax return: Line 43 on Form 1040 OR Line 27 on Form 1040A OR Line 6 on Form 1040EZ

$0 -- $23,940$23,941 -- $32,460$32,461 -- $40,980$40,981 -- $49,500$49,501 -- $58,020$58,021 -- $66,540$66,541 -- $75,060$75,061 -- $83,580$83,581 or more
SECTION B: REQUIRED IF YOU RECEIVED BENEFITS
Did your household receive any of the following sources of support in 2024? (Check all that apply):

Social security benefitsFood stamps/ SNAPAid to Families with Dependent ChildrenVeteran’s benefitsUnemployment benefitsDisability benefitsOther
AUTHORIZATIONS AND SIGNATURES:

AUTHORIZATION TO OBTAIN AND UTILIZE IMAGES –By signing below, the parent/guardian of the student applicant hereby grants permission to SCC Educational Talent Search to photograph and/or videotape either the adult parent/guardian or the minor child upon admission into SCC ETS. The parent/guardian also authorizes SCC ETS to use and/or permit others to use the aforementioned images in educational, informational, and promotional activities for SCC ETS without compensation.

AUTHORIZATION TO RELEASE ACADEMIC / EDUCATIONAL INFORMATION – The parent/guardian authorizes the student’s schools to release any academic/educational information from the student’s files that are requested by SCC ETS and authorizes SCC ETS to release academic/educational information to assist in the student’s education.

I agree to the above statements and verify that by signing this document and submitting the requested documentation that the income and personal information which I have provided is accurate to the best of my knowledge. I understand that the information will be held in complete confidence by the Educational Talent Search program at Shawnee Community College.
Student Signature:

Clear
Date:

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature:

Clear
Date:

MonthDayYear
mm-dd-yyyy

TRIO - Educational Talent Search Shawnee Community College Application

STUDENT INFORMATION:

FIRST GENERATION STATUS:

PARENT / GUARDIAN INFORMATION:

INCOME ELIGIBILITY: