Are you a citizen of the United States? *
Yes, I am a citizen of the United States
If Yes, Social Security Number required
No, but I am an eligible non-citizen
If No, Permanent Resident Number required A
Does the student's parent/guardian have a 4-year college degree? *
Is anyone else in your family receiving services from TRiO ETS?
If yes who?
Ethnicity: Are you Hispanic/Latino? *
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Two or more races
Enter your household's current income or taxable income from the last IRS tax form you submitted. Note: this information is required by the federal government to ensure we are providing services within our guidelines.*
Do you qualify for any of these programs?
Free & Reduced Lunch
Parent/Student: Please check all topics for which you/your child would like to receive information, counseling and/or assistance: Check all that apply
Assistance with High School/early College Course Selection (a)
College Information / Admissions Application Assistance (b)
Financial Aid Information / Application Assistance (c)
SAT/ACT Prep (d)
College Tour/Cultural Event (e)
Financial Planning/Education (f)
Career Information/Counseling (g)
Tutoring/Referral to Academic Tutoring (h)
Assistance Reentering High School/GED Program (i)
Please check the following items that most closely relate to your educational endeavors: 1 box checked required*
Bachelor Degree or Beyond, Attend Four Year College (k)
A.A. Degree/Transfer from Community College (l)
Vocational School or Training Program (m)
Join Military (n)
Seek Employment Directly after high school (o)
STUDENT & PARENT CONTRACT: In order for us to serve you with a strong academic, cultural, and collegiate program, we must have a sincere commitment from you. Please carefully review the following:
I, the student, understand that during my participation in Educational Talent Search (ETS):
I, the parent or guardian, hereby certifies that this information is correct to the best of my knowledge. With my signature, I am granting all TRiO ETS personnel access to the information contained on this form for the purposes of program recording, tracking, and reporting as required by the U.S. Department of Education. I allow TRiO ETS personnel to conduct research pertaining to my educational outcomes as they relate to the TRiO ETS program using phone, email or other digital mediums.
I, the parent or guardian, hereby authorize ETS to contact and request information from, as well as to share information with, the above mentioned parties both while my child is a participant and afterwards when in college. I give my son/daughter permission to participate in ETS activities if accepted. Our signatures below indicate our commitment to the ETS Student & Parent Contract.
I hereby authorize Rogue Community College to use the following identifiable information regarding my child for the purpose of educational publications, promotional advertising and/or other materials or presentations:
To the best of my knowledge, all information provided in this application is true.
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Rogue Community College does not discriminate in any programs, activities, or employment practices on the basis of race, color, religion, ethnicity, use of native language, national origin, sex, sexual orientation, gender identity, marital status, veteran status, disability, age, pregnancy, or any other status protected under applicable federal, state, or local laws. For further policy information and for a full list of regulatory specific contact persons visit the following webpage: www.roguecc.edu/nondiscrimination.