First Name *

Middle Initial

Last Name *

Phone Number *

Please select phone number type *
- Select Option Home Phone Student Cell Phone Parent Cell Phone

Student Email (please provide the email address you check most regularly) *

If you have a second email address, please enter it here

Address Line 1 *

Apartment # (if applicable)

City *

State *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

We also invite you to follow our Facebook and Instagram pages. You can find us under "GVSU Educational Talent Search - ETS" on Facebook, and "gvsutrio_ets" on Instagram.

If you're willing to receive direct messages from us on Facebook, provide your Facebook username

If you're willing to receive direct messages from us on Instagram, provide your Instagram username

Parent/Guardian Name *

Relation to student (e.g. Mother, Father) *

If the parent/guardian address is the same as the student address entered above, type "same." If not, please complete all fields with the parent/guardian address.

Address Line 1 *

Apartment # (if applicable)

City

State/Province
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal

Parent/Guardian Phone Number *

Please select phone number type *
- Select Option Home Phone Cell Phone Work Phone

Alternative Phone Number (Optional)

Please select phone number type
- Select Option Home Phone Cell Phone Work Phone

Parent/Guardian Email *

If you're willing to receive direct messages from us on Facebook, provide your Facebook username

If there is no second parent/guardian, type "NA."

Parent/Guardian Name *

Relation to student (e.g. Mother, Father)

Parent/Guardian Phone Number

Please provide contact information for two other family members or friends (NOT the student's parent/guardian) who we could contact in case of an emergency. 

Full Name *

Relation to Student *

Phone *

Full Name *

Relation to Student *

Phone *

Student's Date of Birth *
Month: - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: - 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Gender *
- Select Option Male Female

Current School (2021-2022) *
- Select Option Burton Middle Godwin Middle School Riverside Middle Westwood Middle Wyoming Junior High Southwest Community Campus Godwin High School Innovation Central High School Ottawa Hills High School Union High School Wyoming High School Not listed Please specify a value for Current School (2021-2022)

Current Grade Level (2021-2022) *
- Select Option 6th 7th 8th 9th 10th 11th 12th

Current GPA *

Expected high school graduation year

Are you behind in credits?
- Select Option Yes No

Race & Ethnicity (check all that apply) *
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino/a
Native Hawaiian or Pacific Islander
White or Caucasian

Student lives with (check all that apply) *
Mother
Father
Step Parent
Legal Guardian
Not listed Please specify a value for Student lives with (check all that apply)

What is the primary language spoken in your home? *

Student's Citizenship/Residency Status *
- Select Option U.S. Citizen Permanent Resident Visa Holder Not listed Please specify a value for Student's Citizenship/Residency Status

If you selected "Visa Holder" please specify what type of visa you have.

If you, the student, are not a U.S. citizen or permanent resident, please contact our office to see whether you are eligible for the program. 

Do you plan to continue your education after high school by attending either a vocational school, 2-year college, or 4-year college? *
- Select Option Yes No

What career(s) are you interested in? *

Are you currently in any of the following programs? *
KCTC
Middle College
Dual enrolled in college classes (but not as part of a Middle College program)
TRIO Upward Bound (Note: you can only be in one TRIO program at a time.)
Gear Up
ROTC
None of the above

How can TRIO ETS help with your academic success or your future goals? *
Please select at least 2 options
Academic / College Planning
Career Interest Testing
College Application Assistance
College Visits or Field Trips
Cultural Activities
Financial Aid Information
Financial Literacy
High School or Post-secondary Course Selection
Goal Setting
SAT Prep
Scholarship Information / Assistance
Summer Opportunities
Test Taking / Study Skills
Tutoring Referral
Other

Have either of your parents/guardians earned a 4-year Bachelor's degree? *
- Select Option Yes No

If yes, please enter the name of the college or university, and the degree earned.

This section should be completed by a parent/guardian.
Note: All information provided is confidential and used only to determine the student's eligibility for the program.

How many people lived in your household in 2020? (Note: unless the student lives alone, this number should be at least 2.) *
- Select Option 1 2 3 4 5 6 7 8 9 10 11 More than 11

According to your 2020 tax forms, what is your household's taxable income? Please note: This is NOT your total annual salary or gross income. Your taxable income for 2020 can only be found on Tax Form 1040, line 15.) *
- Select Option $0 - $19,140 $19,141 - $25,860 $25,861 - $32,580 $32,581 - $39,300 $39,301 - $46,020 $46,021 - $52,740 $52,741 - $59,460 $59,461 - $66,180 $66,181 - $72,900 $72,901 - $79,620 $79,621 - $86,340 $86,341+ Did not file 2020 taxes

If you did NOT file taxes, please write your family's total income for 2020 here. (Note: we may give you a call to ask for more information to determine eligibility.)

Has there been a reduction in your household income since 2020? *
- Select Option Yes No

Please select which of the following your household is currently receiving, if any: *
Public Assistance (WIC, ADC, food stamps)
Medicaid
Social Security Benefits
Free/Reduced School Lunch
Unemployment Compensation
None of the Above

Has the student/applicant received Medicaid in the past?
- Select Option Yes No

Please read each statement carefully. Your signature implies consent.

• We certify that all information provided on the application is the truth and correctly noted to the best of our knowledge.
   
• We authorize the release of the applicant’s school records (transcripts, standardized test scores, free/reduced lunch record, IEP), and college enrollment/National Student Clearinghouse information (financial aid, admissions information, postsecondary degree attained) to TRIO ETS.
   
• We understand that participation with TRIO ETS does not guarantee admission to college or receiving financial aid/scholarships.
   
• We understand that excessive absenteeism, inadequate academic progress, lack of participation in program services, failure to communicate with the TRIO Advisor during the academic year, failure to submit required documents, or failure to follow the student code of conduct can result in dismissal from the program.
   
• We understand that all information on this application will be confidential per FERPA federal law, and shared with no one.
   
• We authorize the use of the student's image or work in TRIO ETS publications, media, and social media releases, unless we have spoken with a TRIO ETS staff member to request an exception due to special circumstances and the TRIO ETS office coordinator has documentation of the request in writing. 
   
• I, the parent or guardian of the above student, agree to encourage him/her to attend all TRIO ETS workshops, communicate with his/her TRIO Advisor, and attend a post-secondary certificate program or college immediately after high school graduation.
   
• I, the parent or guardian of the above student, agree to communicate with my son or daughter's TRIO Advisor to provide updates on his/her academic progress when requested.
   

• I, the parent or guardian of the above student, give consent for him/her to participate in virtual TRIO ETS workshops and events, including those sponsored by TRIO ETS but presented by other institutions, businesses, organizations and persons.

Sign here to indicate your agreement to the statements above, as the parent/guardian of the applicant. (Click and drag with your mouse to sign.)

Date Signed by Parent/Guardian *
Month: - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: - 2022 2021 2020

Sign here to indicate your agreement to the statements above, as the student/applicant. 

Date Signed by Student *
Month: - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: - 2022 2021 2020

Please explain any considerations TRIO ETS should make while reviewing your application, and how the student can benefit from a pre-college program. (Either a parent/guardian or student can complete this section.) *

Completing this application does not guarantee acceptance into the program. If your application is approved, we will send you a welcome letter via mail or email. You will also receive a phone call from a TRIO Advisor to explain more about the program and give you a brief orientation. 

Expectations for students accepted into the program: 

• Students must attend workshops (either virtual or in person) each semester in order to remain in the program. 
• Students must communicate regularly with their TRIO Advisor and respond to communication from program staff.
• Students must maintain a 2.0 GPA. If in danger of falling below a 2.0, contact your TRIO Advisor to construct an academic plan.
• Membership in the program continues until graduation from high school, unless you notify us that you wish to leave the program sooner. 

We also encourage you to attend our field trips, virtual activities, and summer programming.

When you reach your senior year, we may ask for your Social Security Number in order to verify your college enrollment through National Clearinghouse.  

The TRIO Educational Talent Search program is funded by the U.S. Department of Education.