• Educational Talent Search Application

    • Student Information  
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    • Emergency Contact Information  
    • This should be a non Parent emergency Contact

    • Custodial Parents/Guardian Information  

    • Biological or Adoptive Parent Information  
    • Confidential Family Income and Information  
    • We are required by the U.S. Department of Education to obtain family income and other eligibility information from all participants served by the ETS Program. Please complete the following and return this and all requested documents to the ETS Program office. All information will be held in strict confidence. Your application will not be reviewed without the following information.

      You will need your tax return or information from your tax return to finish this page.

    • I verify that by signing this document and submitting the requested documentation that the information which I have provided is accurate to the best of my knowledge. I understand that this information will be held in complete confidence by the ETS Program at Mount Wachusett Community College.
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    • Parent Consent and Liability Release  
    • I, {parentguardianName77} give my son/daughter/ward, {applicantName} permission to participate in the Mount Wachusett Community College (MWCC) Educational Talent Search (ETS) Program. I also absolve MWCC, the ETS Program, their personnel and the Fitchburg, Gardner, and Leominster School Systems of any liabilities and claims arising from my child’s participation, and attendance in MWCC ETS program, including travel to and from such events and activities.

      I consent to and authorize emergency and non-emergency medical care to be provided to my child in the unlikely event of a health problem, emergency or injury occurring during my child’s attendance in the ETS program. I give my consent and authorization to appropriate ETS members to use their judgment in seeking medical care for my son or daughter. I understand that an attempt will be made to contact me in the event that emergency medical care is needed.

      I give permission for the ETS program to obtain the academic records/information for the above named student throughout his/her high school career and for six years following his/her graduation to allow for annual tracking of ETS participant’s education as is required by Federal Department of Education regulations to evaluate the ETS Program. I understand that this information will be held in compliance with FERPA and other applicable state laws and will only be accessible to appropriate program staff and Department of Education personnel.

      I further give permission for the ETS program to use pictures, videotapes or audio recordings of the above named student for all program related purposes, including for publication in newspapers and other media. If I do not wish for the ETS program to use pictures, videotapes or audio recordings of the above named student I will submit written notification to the program and attach to this application. This consent will remain in effect until its written revocation is received by the ETS program at MWCC, 444 Green Street, Gardner, MA 01440.

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    • Student Code of Responsibility and Expectations  
    • 1. Students are expected to attend school every day.
      2. Students are expected to meet with their TRIO advisor.
      3. Students are expected to attend any and all workshops, and to fully participate in the program.
      4. Students are expected to demonstrate model behavior in and out of school, including while on any and all field trips.
      5. Students are expected to take advantage of everyopportunity offered in order to make their time with us as beneficial as possible.
      6. Students are expected to share academic information with ETS staff in order to assist in planning and tracking. Student must also
      give staff permission to access information relating to their academic progress.
      7. Students are expected to have fun and do their best!

      I have read the above rules and promise to uphold them and to be a good representative of my school and the ETS program. I understand that any serious breach of behavior may result in dismissal from the program.

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    • Student Needs Assessment  
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    • Submit  
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