New Application for the TRIO Talent Search Program

2022-2023 Academic Year

Florida Gulf Coast University

10501 FGCU Boulevard S.

Fort Myers, FL 33965

Phone: 239-590-7834   

Fax: 239-590-7947

https://www.fgcu.edu/trio/outreachprograms/

 

The Talent Search Program strives to identify and assist 6th-12th grade students from disadvantaged backgrounds who have the potential to succeed in higher education.

Before completing the application, please review all questions and the required information. You cannot save and restart this application.

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Selection Process

Only COMPLETE applications from eligible students will be reviewed. After the initial screening, eligible applicants will be notified by e-mail.

If you should have any questions about this process, please do not hesitate to contact us at 239-590-7834

Part 1: Student Information 

 
First Name *
Middle Name
Last Name *
Preferred Name
Address *
City *
State *
Zip *
Parent/Guardian Phone *
Student Cell Phone *
Student Email *
Date of Birth *
Gender *
Residency Status *
Ethnicity *
Race *
Current School *
Current Grade Level *
School ID *
Are you taking any Honors/Dual Enrollment/Advanced Placement/International Baccalaurate courses? *

Part 2: Needs Assessment

1. Are you in need of assistance with your academics for better grades?
2. Are you in need of assistance for better study skills development?
3. Are you in need of one-on-one or group tutoring?
4. Do you need help with setting better goals and making wiser decisions?
5. Do you need help developing better money management skills?
6. Do you need help preparing for high school?
7. Do you need help choosing your high school courses?
8. Do you plan on attending college/technical school after high school?
9. Do you need help deciding on a career path that you will enjoy?
10. Do you need help with financial aid or scholarship search?

Part 3: Family/Income Information 

 (To be completed by Parent or Guardian)
With Whom Does the Student Live? *
Parent/Guardian #1 Name *
Relation *
Cell Phone Number *
Work Phone Number
E-mail Address *
Highest level of education completed in the United States *
Parent/Guardian #2 Name *
Relation *
Cell Phone Number *
Work Phone Number
E-mail Address *
Highest level of education completed in the United States *
Is your child eligible for the free lunch program at school? *
Number of People Living in House *
Which income range listed best describes your household's earnings? *
My signature confirms that the above information is accurate. 
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.

Part 4: Parent/Student Consent

CONSENT FOR SERVICES:

I understand pre-college and educational outreach services including but not limited to: academic advising, tutoring referrals, cultural enrichment activities, career and college exploration; will be provided as needed. Services are provided by Educational Talent Search (ETS) staff (counselors, volunteers, mentors, tutors and teachers), and are designed to help student's achieve their academic and personal goals. These services are provided free of charge and at the student's will.
ALL INFORMATION RECEIVED WILL BE KEPT CONFIDENTIAL IN COMPLIANCE WITH THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT.

 

RELEASE OF INFORMATION:
I authorize Educational Talent Search to access academic and personal information in the legitimate educational interest of my student including but not limited to: public assistance, free & reduced lunch documentation; standardized test scores (State testing scores, SAT, ACT, GED); report cards; unofficial transcripts; official transcripts; attendance records; information about the status of post-secondary education admission/enrollment; financial aid documentation including FAFSA pin code, SAR, and award letters in accordance with The Family Educational Rights and Privacy Act (FERP A) (20 U.S.C. § 1232g; 34 CFR Part 99). I understand this information is essential in assisting me/my child in preparation for post­secondary education. I further understand all information received is for ETS use only and is held strictly confidential.

 
I understand that I am giving the Florida Gulf Coast University Educational Talent Search Program's Director, coordinator, and office manager permission to access my student's grade and attendance information directly from appropriate school personnel and to request other academic and behavioral information directly from school staff. I intend to give permission for Educational Talent Search to access and collect this information for the duration of my student's participation in the program and throughout his or her high school and college career; however, if I choose to withdraw this permission, l can call the Talent Search staff at Florida Gulf Coast University (239-590-7834). 

BEHAVIOR AGREEMENT: 

I understand that the rules I am held responsible to at my school campus are the same rules that apply during any event which the Educational Talent Search Program. If any rule is broken, I understand if it becomes necessary, the ETS staff will call my parent/guardian and they will be required to pick me up IMMEDIATELY. I also understand that failure to abide by any of the recognized rules may result in my dismissal from the Educational Talent Search Program. 

IMAGE (MEDIA) RELEASE (Please read carefully)

I give ETS permission to use my child's picture/image and/or accomplishments as a result of my child's participation in the program. These images/pictures may be used on program brochures, flyers, or be published on the program's website to activities and participation. I release any claims against Florida Gulf Coast University, the ETS Program and/or staff for any damages, awards, claims or liabilities which may arise from any unauthorized use or copyright violations of my child's image, picture, or work. 
Emergency Contact Name *
Phone Number *

I consent and verify the information provided above is true to the best of my knowledge. 
Student Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.