Application

Student Information:
First Name *
Middle Name *
Last Name *
Date of Birth *
Gender *
Street Address/P.O. Box *
Street Address - Line 2
City *
State *
Zip *
Home Phone Number
Student Cell Number *
Student Email Address *
Citizenship:
Citizenship *
Race & Ethnicity:
(Please answer each question below by selecting 'Yes' or 'No'.)
American Indian/Alaskan Native *
Asian *
Black or African American *
White *
Native Hawaiian or Other Pacific Islander *
Are you Hispanic or Latino/a? *
Academic Background:
Current Grade Level *
Current High School *
Did you pass the 8th grade standardized test for math? *
Did you pass the 8th grade standardized test for English? *
What is your cumulative GPA for the most recent school year you have completed? *
Are you currently a TRIO Talent Search participant? *
Family Information:
Parent/Legal Guardian Full Name *
Parent/Legal Guardian Phone Number *
Parent/Legal Guardian Email Address *
Parent/Legal Guardian Full Name
Parent/Legal Guardian Phone Number
Parent/Legal Guardian Email Address
Eligibility
Parents' Educational Level *
How many people live in your household? *
Taxable Income (Form 1040, Line 15) *
2022 IRS Form 1040 *
Sign & Submit
Parent/Guardian Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number: