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Rogue Community College
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TRiO ETS Participation

(*Required Form Fields)
Student Information
*
*
*
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State: Oregon
*
(include area code: ###-###-####)*


*
*
*
*
Citizen

Are you a citizen of the United States? *

          

           A

Educational Information *

*

 
 
Parent 1/Guardian
*
*
*
*
State: Oregon
*


Parent 2/Guardian
State: Oregon


Does the student's parent/guardian have a 4-year college degree? *


Language spoken at home:  

Is anyone else in your family receiving services from TRiO ETS?


If yes who?  

School Age Siblings:
(Name)
Grade
(6-12th only)
School they attend

Ethnicity: Are you Hispanic/Latino? *


Race: *






Income Documentation Information TOTAL NUMBER OF HOUSEHOLD MEMBERS SUPPORTED BY THIS INCOME: *

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?


 

Check all that apply

Parent/Student: Please check all topics for which you/your child would like to receive information, counseling and/or assistance: Check all that apply
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)

If other:  
Check at least one

Please check the following items that most closely relate to your educational endeavors: 1 box checked required*
(k)
(l)
(m)
(n)
(o)
(p)

If other:  
Contract

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):

  1. My goal will be to complete middle/high school and pursue post-secondary education.
  2. I will maintain at least a 2.5 GPA in middle school and in high school.
  3. I will accept appointments and attend all meetings and workshops arranged by my ETS Advisor.
  4. I will complete all required forms and provide document of completion (FAFSA, Admissions forms, etc.)
  5. I will abide by all rules and regulations of Educational Talent Search and Rogue Community College.
  6. Poor attendance or lack of participation will be a basis for dismissal from Educational Talent Search.
* Student Name: *

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:

  • Photographs, images, or likeness
  • Information related to child's classroom, school, and/or district
  • Student's name

To the best of my knowledge, all information provided in this application is true.

* Parent Name: *