Educational Talent Search Application - Prairie State College

202 South Halsted StreetChicago Heights, IL 60411-8226(708) 709-3500 - Fax (708) 755-2587prairiestate.eduStudent ________________________Grade _________________________School _________________________Dear Prospective Student,Congratulations! You have been recommended by your counselors to participate in the TRiO Talent Searchprogram this school year! We look forward to your joining us for this educational experience.TRiO Talent Search activities include: College visits (transportation and meal included)o Past college visits includes schools like:• Grand Valley State University• University of Illinois at Chicago• Northern Illinois University Career exploration activities Information on colleges, universities, and majors Assistance with completing college applications Assistance with the Free Application For Federal Student Aid (FAFSA)All of the services we provide are free of charge.Spots for college visits will be filled on a first come first served basis; the first students to submit theirpermission slips on time will be able to participate.We look forward to meeting with and assisting you in your academic plans and working with you during thisschool year. If you have any questions please call Mr. Davenport at (708) 709-7917 or visitwww.prairiestate.edu/talentsearch to find our e-mail addresses and more information about the program.Sincerely,Jason ThomasDirector, TRiO-Talent Search ProgramP: 708.709.7940 F: 708.709.7934LTR 8 -14

Prairie State CollegeEducational Talent SearchInformation Waiver Form (ETS)I hereby give permission for ________________________________________ to participate in the Educational TalentSearch Program which will provide tutoring, mentoring, field trips, and support services.In addition to assisting our staff in providing counseling the student, the information that you provide will be used forpreparing statistical reports. These reports will protect your anonymity, and will be confidential, as they will be of asummary nature only.In order to provide effective services for our students, we may need to obtain additional information from several sourcesto verify a student’s eligibility within the program such as: High Schools, Colleges, and Testing Companies.Your signature below authorizes ETS to:• Request a copy of Elementary, High School/ or College transcripts• Request a copy of your financial assistance applications from the Federal Government, StateFunding Agencies, a Post-secondary Educational Institution, and / or American College TestingCompany or College Entrance Examination Board• Request a copy of attendance records• Request a copy of public aid information• Request a copy test score reports such as IGAP, IOWA, ACT, PSAT, SAT, TAP, and the CaseTest• To supply college representatives with student information for the purpose of providing collegeopportunities• Take pictures of participants during activities to be used in promotional publications____________________________Student Signature___________Date____________________________ ____________________________ __________Signed Parent / or Guardian Print Name DateWVR 8-14

TRiO Participant ApplicationPlease Type or Print in Blue or Black Ink.PROGRAM: Educational Talent SearchSTEP 1 - STUDENT INFORMATIONLast Name: First Name: Middle Initial:Street Address:Apartment#:City: State: Zip: E-Mail:Phone Numbers:(H) _________________________________________(W) ________________________________________(C) _________________________________________School/College currently attending:_____________________________________________________________________School Student ID# (if applicable): ______________________________________Social Security Number:-- --Grade Level: _____________G.P.A.: ______________STEP 2 – STUDENT INFORMATIONEthnicity: American Indian or Alaska Native White Asian Native Hawaiian/Pacific Islander Black or African American More than one race Hispanic or LatinoGender: Male FemaleBirth Date: _____/_____/_____Age:_________________STEP 3 – STUDENT INFORMATIONAre you a U.S. Citizen? Yes NoIf you are not a U.S. Citizen, are you Yes Noa Permanent Resident?Enter Permanent Resident Alien Number:ASTEP 4 – PARENT INFORMATIONHas your father received/earned a four- Yes Noyear degree? If yes, name of school _____________________________Has your mother received/earned a four- Yes Noyear degree? If yes, name of school _____________________________Which parent did you regularly reside with and receive support from Mother Both Mother and Fatherduring your childhood (i.e., until you were 18 years old)? Father Neither Mother nor FatherSTEP 5 – STUDENT INFORMATIONIf you are at least 24 years old, ignore the questions in STEP 5 and skip ahead to STEP 6.If you are less than 24 years old, answer the questions in STEP 5 and then go to STEP 6.Are you in college and working on a master’s or doctorate program (e.g., M.A., MBA, MD, JD, PhD, EdD? Yes NoAre you married? Yes NoDo you have children who receive more than half of their support from you? Yes NoDo you have dependents (other than your children or spouse ) who live with you Yes Noand who receive more than half of their support from you?Are both of your parents deceased, or are you (or were you until age 18) a ward/dependent of the court? Yes NoAre you a veteran of the U.S. Armed Forces? Yes NoSTEP 6 – PARENT INFORMATIONYou must answer the questions in STEP 6 if you are at least 24 years old or you answered YES to any of the questions in STEP 5.Your parent(s)must answer the questions in STEP 6 if you are less than 24 years old and you answered NO to all of the questions in STEP 5. Note: If you are acollege student and dependent on your parents (i.e., you are less than 24 years old and you answered NO to all of the questions in STEP 5), speakwith your FCEA advisor.TS1 8-14

STEP 6 – PARENT INFORMATION (CONTINUED)What is the total number of persons in your family?Please select one of the following boxes: My family’s taxable (not total) income from the last calendar year was: Does student get Free Lunch? Yes ____ No ____$ ,(Note: Your taxable income can be found on the federal income tax return you filed for the last calendar year. On IRS Form 1040, see line 43. On IRSForm 1040A, see line 27. On IRS Form 1040EZ, see line 6. On IRS Telefile, see line K1.) I attest that my family did not file a federal income tax return for the last calendar year. My family’s income was:$ , I attest that my family had no taxable income for the last calendar year.STEP 7Read, sign, and date.By signing this application, you attest that all the information on this application is true. Moreover, you authorize the release of official school records toEducational Talent Search - Prairie State College, understanding that the information in these records will be used only to assess the student’s need forprogram services, discern his/her educational progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements. AlsoI authorize for any pictures/videos taken in connection with the activities of Educational Talent Search - Prairie State College to be used in publications.(i.e., newsletters, television, websites, presentations, magazines articles etc.)___________________________________________________________________________________________ / ________ / ________Student’s/Participant’s Signature Date: MM DD YYYY___________________________________________________________________________________________ / ________ / ________Parent’s Signature Date: MM DD YYYY(Parent’s signature is required if applicant is less than 24 years old and answered NO to all of the questions in STEP 5.)FOR OFFICE USE ONLYThe 20 ________ federal TRIO programs for low-income level for a family unit with __________ members is:$ , Recommended Approval Recommended Approval Approved Not Recommended Not Recommended DeniedReason: _______________________ Reason: _______________________ Reason: __________________________________________________________ __________________________________ _____________________________________________Advisor (Print Name) Director (Print Name) Principal Investigator or Designee (Print Name)___________________________________ __________________________________ _____________________________________________Advisor (Signature) (Date) Director (Signature) (Date) Principal Investigator or Designee (Signature) (Date)Date of Application Entry into Database: ________ / ________ / ________ Initials of Data Entry Staff: _________Eligibility: LI & FG LI ONLY FG ONLY DI ONLY DI & LI Under-represented OTHERProject: ETS UB City UB SuburbanTS2 8-14

Prairie State CollegeEducational Talent SearchWHO IS ELIGIBLE TO PARTICIPATE? Students who are U.S. Citizens or permanent residents Between the ages of 11-27 years old Attend a designated school within the District:Bloom Trail High School, Cottage Grove Middle School, Washington Junior High School Demonstrate financial need according to federal income guidelines Be a first generation college bound student(Neither parent/legal guardian has obtained a four-year college degree) Re-entry students(A student who has dropped out of grades 6-12 and has the ability to complete post-secondary education)HOW DO I APPLY?All Educational Talent Search services are provided free of charge. To apply, please return all formsto Mr. Thomas, the Director of the Educational Talent Search via your school’s guidance counselor.INFO 8-14