ETS Online Application

The information you provide in this application is confidential according to the Family Rights and Privacy Act. The US Department of Education has the authority to gather the information requested in this application (20 USC 1231a). The only persons authorized to examine the contents of this application are the student, their parents, employees at the school attended, and authorized Educational Talent Search staff. 
Student Information
First Name *
Middle Name *
Last Name *
Address *
Address 2
City *
State *
Zip *
County
Student's Home Number
Student's Cell Number
Student's Email *
Are you a citizen of the United States? *
If no, please provide your permanent resident ID#
Date of Birth *
Social Security
Language(s) spoken at home: *
Gender *
Academic Information
Current School *
Current Grade Level *

Cultural Background Information
Are you Hispanic? *
Ethnicity *

Family Information and Eligibility

Educational Talent Search is a federally funded grant aimed to reach individuals with certain incomes and/or whose parents have not obtained a Bachelor's Degree. We are required to ask the following information for this purpose.
Student lives with
Highest level of education of both parents
Does your family qualify for free or reduced lunches?
How many people in your household *
Household income range *
DO NOT USE GROSS INCOME *For Annual taxable income, please use the income of the parent the student lives with 51% of the year. If the answer is zero, type "0". If possible please include a copy of last year's tax return. If you do not file taxes please type "Do Not File".
If the applicant is a ward of the count please provide the Caseworker Name and Number

If applicable, please provide the name and age of all siblings living in the primary household under 18.

Sibling Information
Sibling 1 Name/Grade/Age
Sibling 2 Name/Grade/Age
Sibling 3 Name/Grade/Age
Please list any additional siblings here

Guardian Information

Please fill out the following information for the legal parent(s) or guardian(s) of the student.

Parent or Guardian 1
Full Name *
Relationship *
Student lives with me *
Phone Number
Email
Occupation
Work Phone

Parent or Guardian 2
Full Name
Relationship
Student lives with me
Phone Number
Email
Occupation
Work Phone

Assessment of Student Needs

To enroll in post-secondary education (college), I would benefit the most from the following service (check one only).
*

Media Release Form

Do you give permission your son/daughter to be interviewed, photographed, or videotaped by Educational Talent Search for use on radio, TV, in printed news media, or in program promotional materials and documentations?
Media Release Permission *

College and Educational Plan

After high school, I expect to complete: (Select one)
Top 3 College Choices
My top 3 college choices are:
Top 3 Career Choices
Top 3 Careers

ETS Authorization Consent

I/we authorize Education Talent Search (ETS) to obtain documents relative to and consistent with my child's education. Such documents may include: a copy of school transcripts, report cards, test scores, ACT/SAT or GED scores, and school lunch program eligibility. I/we authorize ETS to obtain information related to my application for receipt of the student financial assistance (federal, state or other), a copy of my award notification from the financial aid office, and college admission information. I/we authorize ETS to release to or obtain information from any agency or program providing supplemental services. We would like to be a part of the ETS program. I hereby give my permission for my child to participate in all ETS activities. 

Your digital signatures below testify to the accuracy of all information provided on this application.

PAUSE - Please wait a few moments for the signature pad to appear after clicking E-Signature.
Fill out one signature box at a time. 
Student Signature *
Please select a signature verification type.
Parent Signature *
Please select a signature verification type.