Please complete all four sections of the application and click the SUBMIT button when complete.
Section 1: Student Information
Section 2: Family Information
Section 3: Student Needs Assessment
Section 4: Parent/Guardian Consent and Liability Release

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Section 1 of 4
Student Information
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Check here if you do NOT want to receive texts:
Gender Identity:
Ethnic Background
Citizenship
High School
Do you live in foster care?
Do you participate in Upward Bound?


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Section 2 of 4

Family Information
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To be completed by the parent or guardian.


The Talent Search Program is required by the U.S. Department of Education to collect family income and other family information from all participants. Applications will not be reviewed until this information is complete. All information is kept confidential.


List all people living in your home, including student
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Student 
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Home Occupant #1
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Home Occupant #2
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Home Occupant #3
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Home Occupant #4
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Home Occupant #5
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Home Occupant #6
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Has the student's MOTHER earned a Bachelor's Degree from a 4-year university or college in the U.S.?
Has the student's FATHER earned a Bachelor's Degree from a 4-year university or college in the U.S.?

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Taxable Family Income
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Did the family file a Federal Income Tax Return last year?

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Parent/Guardian Certification and Signature
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I verify that by signing this document the information which I have provided is accurate to the best of my knowledge. I also understand that the information I have provided will be used to document the student’s eligibility for the TRIO Talent Search Program. I understand that this information will be held in complete confidence by the Talent Search Program at North Shore Community College.



By typing NAME you are verifying as a signature
month / day / year

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Section 3 of 4
Student Needs Assessment
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To be completed by the student


Please answer all of he following questions to help us determine how the program can meet your needs.

What kind of college/university do you want to attend?
Please select all the TRIO Talent Search programs and services you think you need (check all that apply):
Would you like tutoring in:

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Section 4 of 4
Parent/Guardian Consent and Liability Release
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I (parent/guardian) give my son/daughter/ward permission to participate in the North Shore Community College (NSCC) Talent Search (TS) Program. I also absolve NSCC, the Talent Search Program, their personnel, and the Lynn Public School District of any liabilities and claims arising from my child’s participation and attendance in the program, including travel to and from events and activities. Further:

Medical release: 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 TS program. I give my consent and authorization to appropriate TS staff to use their judgment in seeking medical care for my son or daughter. I understand that an attempt will be made to contact me if emergency medical care is needed.

Mandated reporting: I permit the TS 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 TS participant’s education as is required by Federal Department of Education regulations to evaluate the TS 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.

First and Last name
By typing NAME you are verifying as a signature
By typing DATE you are verifying as a signature

MEDIA RELEASE
Request for Talent Search program and affiliates 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.
By typing NAME you are verifying as a signature
By typing DATE you are verifying as a signature

STUDENT CONSENT AND PARTICIPATION AGREEMENT

I (student) understand that by participating in the Talent Search Program I will be participating in a federally funded TRIO program designed to help me graduate high school and continue on to post-secondary education. Accordingly, I understand that I am subject to the program policies and procedures and if accepted into the program, I agree to the following:

  1. To strive to attain personal, academic, and career goals that I set for myself. 
  2. To treat myself, other students, and staff with respect, and be a positive representative of the program.
  3. To attend school every day.
  4. To periodically/as scheduled meet with my TRIO advisor
  5. To attend relevant workshops and to fully participate in the program.
  6. To demonstrate model behavior in and out of school, including while on TS field trips.
  7. To share academic information with TS staff in order to assist in planning and tracking.
  8. To have fun and do my best!

I have read the above rules and promise to uphold them and to be a good representative of my school and the TS program. I understand that while participating in TS activities I am held to the TS program policies and the policies outlined in my school’s student handbook and that any serious breach of behavior may result in dismissal from the program.

By typing NAME you are verifying as a signature
By typing DATE you are verifying as a signature


Additionally, I understand that to facilitate successful participation in the program and for data reporting, TS staff need access to my academic records throughout my participation in the program and my post-secondary enrollment and graduation information after high school. I understand this consent will remain in effect until its written revocation is received by the TS program at NSCC, 1 Ferncroft Road, Danvers, MA 01923.

By typing DATE you are verifying as a signature
By typing DATE you are verifying as a signature
 
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