Educational Talent Search is a federally funded TRIO ...



Educational Talent Search (ETS) is a federally funded TRIO Program designed to assist middle/high school students with completing high school or the GED and enrolling into a postsecondary institution. The program also assists college stopouts with re-enrolling into a postsecondary institution. The services provided to their participants are listed below under the Needs Assessment section. All ETS services are free. ETS participants must be citizens or permanent residents of the United States.

Students who attend one of the Waterloo Public middle/high schools (Bunger, Central, George Washington Carver Academy, Hoover, East, Expo or West) high school graduates, and high school/college stopouts living in Black Hawk County in 6th grade through age 27 are eligible to apply.

All completed applications will be evaluated and the most qualified students will be accepted into the program. Middle/high school students may return their application and school records release form to their school or mail to the ETS Program office. High school graduates, high school and college stopouts should return their application and school records release form to the ETS Program office. Please contact the ETS office at 433-1220 if you have any questions.

Name: Last First MI Birth Date

_________________ ( Male

Street/Mailing Address City State Zip Code ( Female

_______________________

Social Security # (optional) Home Telephone # Emergency Telephone # Cell Telephone # (optional)

Student’s E-mail Address School Presently Attending

Race/Ethnicity: ( Black or African American ( White ( Hispanic or Latino ( Asian

( American Indian or Alaskan Native ( Native Hawaiian or Other Pacific Islander

Current Academic Level: ( 6th ( 7th ( 8th ( 9th ( 10th ( 11th ( 12th ( High School Graduate

( GED Recipient ( High School Stopout ( College Stopout

Is the applicant a US citizen or a permanent resident? ( Yes ( No (If no, you are not eligible for ETS)

Is the applicant a ward of the court? ( Yes ( No Is the applicant living in a foster home?( Yes ( No

Is the applicant homeless? ( Yes ( No Is the applicant a veteran? ( Yes ( No

Is the applicant homeschooled? ( Yes ( No

Does the applicant have any disabilities? ( Yes ( No If yes, please specify: ______________________________

______________________________________________________________________________________________

Is the applicant enrolled in an Upward Bound Program? (Yes ( No

Does the applicant plan to attend a 4 yr. college, vocational school or community college after high school? (Yes ( No

Needs Assessment: Please check the workshops and activities you believe will be helpful to you:

_____Course Selection _____Cultural Events _____College Tours _____Study Skills

_____ACT/SAT Prep _____GED Assistance _____Career Planning _____ACT/SAT Fee Waiver

_____ Financial Aid _____Tutoring _____College Admissions _____Scholarships for College

_____ Financial Literacy _____ Goal Setting _____ Time Management

(Complete Back Side)

Name of Parent(s) or Legal Guardian(s): Cell #:

Last First

Cell #:

Last First

Parent(s)/Guardian(s) email address:

ETS is required to verify that our participants meet federal criteria based on educational background and household income.

ETS ensures that all information provided will remain confidential.

Have either biological or adoptive (not step) parents of the student graduate from a four-year college and receive a Bachelor’s degree? ( Yes ( No

If yes, please list school:

What is the primary language in your home? __________________________________

Total number of people living in the household: _______

If you filed a 2012 income tax return please check the income range that is closest to your taxable income on Form 1040, 1040A or 1040E Z.

О under $$17,235

О $17,236 - $23,265 О $47,386 - $53,415

О $23,266 - $29,295 О $53,416 - $59,445

О $29,296 - $35,325 О $59,446 - $65,475

О $35,356 - $41,355 О $65,476 - $71,505

О $41,356 - $47,385 О $71,506 - $77,535

If you did not file a 2012 income tax return please list your taxable income:

I (we) grant ETS permission to take photos of my child and use them to promote the Talent Search Program. (Yes (No

I verify that the information provided on this application is true, complete and accurate to the best of my knowledge.

Statement of confidentiality

The personal information you submit to the UNI Educational Talent Search Program is necessary to determine if the student is eligible to participate in the program. This information is protected by the Privacy Act and no one may see this information unless they work with or for the University of Northern Iowa Educational Talent Search Program.

_______________________________

Parent/ Guardian Signature Date

Educational Talent Search Program

800 Sycamore St.

Waterloo, IA 50703-4730

319-433-1220

Revised: July 2013

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UNIVERSITY OF NORTHERN IOWA EDUCATIONAL TALENT SEARCH STUDENT APPLICATION

Student Information (Please Print)

Parent/Guardian Information

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