Shawnee Community College-TS-2026 Application Form

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Full Name:

First NameLast Name

Preferred Name:

School:

Grade:

Birthdate:

mm-dd-yyyy

Age:

Student Email:

example@example.com

Gender:

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:

Are you Hispanic/Latino?

Are you a US citizen?

If you marked NO, are you a permanent resident?

Please provide your permanent resident number:

Please select one or more options listed below:

NEEDS ASSESSMENT: Which needs can Talent Search help you with this year? (Check as many as apply):

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):

If you are a middle school student, what kind of grades do you typically make in school?

Are you currently a member of TRIO Upward Bound or Upward Bound Math & Science?

Does the student’s FATHER have a 4-year college degree?

College:

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

College:

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:

Email address:

example@example.com

Relationship to student:

Circle the response that applies:

Other

Does the student live with this parent?

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:

Email address:

example@example.com

Relationship to student:

Circle the response that applies:

Other

Does the student live with this parent?

How many people are in your household?

Does the student/family qualify as homeless?

Did you file a tax return in 2024?

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

SECTION B: REQUIRED IF YOU RECEIVED BENEFITS

Did your household receive any of the following sources of support in 2024? (Check all that apply):

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:

Date:

mm-dd-yyyy

Parent/Guardian Signature:

Date:

mm-dd-yyyy

TRIO - Educational Talent Search Shawnee Community College Application

STUDENT INFORMATION:

FIRST GENERATION STATUS:

PARENT / GUARDIAN INFORMATION:

INCOME ELIGIBILITY: