TRiO Educational Talent Search Program Application

HEC-Educational Talent Search Program Application
Educational Talent Search (ETS) is a college preparation and readiness program which provides middle and high school students the opportunity to acquire the academic skills, career awareness, and information necessary for students to overcome the challenges to successful college completion. ETS identifies and develops academic talent in the St. Louis Public School System and connects them with institutions of higher education.

The mission of the Higher Education Consortium (HEC) of Metropolitan St. Louis is to enhance student access and achievement in higher education.

Section IV: Release of Records/Information
Section IV: Release of Records/Information
Release for Photographic and Digital Images

I give permission to HEC Educational Talent Search the right to reproduce, distribute, transmit, publish, display, in whole or in part, either digitally or in any other medium the use of my child’s name and/or photographic image.
CHOOSE ONE

I AGREEI DISAGREE
Activities/Promotional Release

I give permission for my child to participate in HEC ETS-sponsored field trips, college tours, social and cultural activities.

I also give permission for the use of my child’s name and/or photograph for editorial, promotional, recruitment and/or educational purposes. I will participate in my child’s ETS activities and encourage my child to do the same.
CHOOSE ONE

I AGREEI DISAGREE
Release of Information

With my signature below, I hereby grant permission to the TRiO Educational Talent Search (TRiO ETS) staff to access high school records which include: copies of school district records including, but not limited to class schedules, grades, transcripts, test scores, free and reduced lunch eligibility, address, phone number, suspension and disciplinary records, IDEA information, FAFSA confirmation documents, etc.

I hereby authorize postsecondary institutions, National Student Clearinghouse (NSC), etc. to release to TRiO ETS, college, academic, and enrollment information, as well as all student aid awards at the chosen college, attended after high school until the completion of a certificate/degree from a post-secondary institution.
Type a question
Parent Signature

Clear
Date*

MonthDayYear
Date
CHOOSE ONE

I AGREEI DISAGREE
Student Agreement

If accepted to the program, I, {studentName}, agree to attain all personal, academic, and career goals that TRiO staff and I have set. I agree to attend workshops and activities. I am expected to follow the same rules of conduct and dress code established by my school district.

This is to include: 1) No alcohol, drugs, or smoking/vaping at any time

2) No profanity or horseplay at any time, and

3) Fighting and disrespectful behavior toward others will not be tolerated.

Additionally, I agree to treat other students, staff, and myself with respect and be a positive representative of the program. By violating this policy, I shall be subject to disciplinary sanctions, which may include suspension and/or termination from the TRiO Educational Talent Search Program.
Student Signature

Clear
Date

MonthDayYear
Date
We want to get to know you! Upload a photo
TRIO programs are federally funded programs designed to ensure equal educational opportunity for all individuals, regardless of race, gender, ethnic background, disability, or economic circumstance.

Section V. Medical Information
Section V. Medical Information And Consent Form
The following information would be used if ever {studentName} were on a field trip with us

Student Name: {studentName}

Date of Birth: {studentDate}

Address: {currentAddress}
Is the student covered by any medical insurance?
Policy#
Please list any personal or family medical history that may be of importance for our records, including allergies and physician-prescribed medication that {name} is currently taking:

	List Medications/Medical History	Allergies/Allergic Reaction	Diagnosis
1
2
3
4

Which parent or guardian should we call case of emergency or serious accident or illness?

{parentguardianName} {parentEmail198} {parentguardian128}

{secondParentguardian} {secondParentguardian35} {secondParentguardian37}

Is that correct?
YesNo
Alternate Emergency Contacts

If I cannot be reached, necessary interim emergency care may be provided. I understand that HEC Educational Talent Search staff will contact these individuals listed in case of emergency (Please provide name, relationship and telephone number of three emergency contacts)
Contact #1

First NameLast Name
Relationship to Student
Phone Number

Area CodePhone Number
CONTACT #2

First NameLast Name
Relationship to Student
Phone Number

Area CodePhone Number
CONTACT #3

First NameLast Name
Relationship to Student
Phone Number

Area CodePhone Number
Parent/Guardian Signature (Use mouse or finger)

Clear
Date

MonthDayYear
Date

Section VI. Enroll Additional Student
Would you like to add another child?

Yes, I would like to add another childNo, I do not need to add another child
Great!! If you would like to add another child, you will have the opportunity when you submit this form.
Could you recommend a friend/relative who could benefit from our program?

Yes, I can recommend a friend/relativeNo, I am not able to recommend anyone at this time
The friend/relative I would like to recommend is First Name Last Name . Their phone number is Area Code Phone Number and their email address is Email.

Sign and Submit
Parent Signature

Clear
Should be Empty:

HEC-Educational Talent Search Program Application

Section II: Family Information

Section III: Parent/Guardian Contact Information

Section IV: Release of Records/Information

Section V. Medical Information And Consent Form

Alternate Emergency Contacts