Educational Talent SearchLake Tahoe Community College

One College DriveSouth Lake Tahoe, CA 96150

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Dear Applicant and Family:

Congratulations on your dedication to education ! Educational Talent Search {ETS) is afederally funded program administered by Lake Tahoe Community College. Thepurpose of the program is to prepare and rnotivate low-income and/or potential firstgeneration college students to successfully complete middle school and high schooland go on to college. We are passionate about guiding students and their familiesstep-by-step through the college and financial aid processes. All program services areFREE, but we expect students to make a serious commitment to both their educationand the ETS program. Students accepted into the ETS Program are participants untilthey graduate from high school. ALL information provided in this application isconfidential.

Sincerely,

Darren McKay- STHS Program SpecialistGladys Aguilar Garcia- STMS Program Specialist

APPLICATION CHECKLISTTo complete the ETS application, please include:

1. Student lnformation: Student's social security nurnber, or one of thefollowing:

. Copy and number of green cardo DACA documento lmmigration letter

2. Parent lnformation/Acknowledgement:r Parents'educationlevelr Signed copy of most recently submitted tax forms

{pages 1 & 2 of the 1-040 or 1040A)r Student Needs Assessmento Student Agreement

For questions, or to submit an application please contact:

South Tahoe High School Attn: Darren McKay - ETS1735 Lake Tahoe Blvd. South Lake Tahoe, CA 96150t530) 541-4111 ext. 1810 mckav@ltcc.edu

South Tahoe Middle SchoolAttn: Gladys Aguilar Garcia - ETS2940 Lake Tahoe Blvd. South Lake Tahoe, CA 96150t5301 541-540tt ext. 1744 sasarcia@ltcc.edu

ETS Program lnformation TRiO{: I}r.,,c,\l lr.}l\iA( IAI f N1 5l A*{a t'-{

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The ETS Program is here to help support students and their families to achieve educational andpersonalgoals! lt is designed to serve:

Students whose parents did not graduate from a four year collegeLow-income students

To be admitted to the ETS Program, students must be committed to reaching the following goals:

o Complete the current academic year and continue in school for the next academic year, atthe next grade level

o Complete a rigorous secondary school program of studyo Graduate with a regular high school diplomao Enroll in an institution of higher education by the fall term immediately following high school

graduationr Obtain a college degree

ETS participants receive:

Tutoring servicesAcademic, financial, and career guidanceCareer exploration and planning assistanceAssistance in completing college admissions and financial aid applications step by stepWorkshops to develop skills for successFREE trips to four-year schoolsFREE trips to cultural eventsAssistance in preparing for college entrance examsWorkshops for parents in English and Spanish to provide information and support

QUESTIONS??

Contact ETS Staff:

Darren McKay at STHS Rm. AL from 8:00am - 4:00pm M-FPhone: (530) 54L-4111ext. 18L0 Email: mckay@ltcc.edu

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Gladys Aguilar Garcia at STMS Room 44from 8:00am- 4:00pmPhone: (530) 541-6404 ext.1744 Email: gagarcia@ltcc.edu

TR|O - Educational Talent Search Application 2014-2015South Tahoe Middle School, Rm. 44 .2940 Lake Tahoe Blvd. .So. lake Tahoe, CA 96150 .(530, 541-6404 ext. 1744

All information is required to process your application.lncomplete applications will not be processed. All infomation is CONFIDENTIAL.

Student Name:

a!ffelUslrlytrL|/FGf]FGDLInother_Date received_Date processed

Approved by

(last) (first) (middle)Mailing Add

Home Phone# (-)

nus cttizenI Letter fromE Permanent

re4urTe/)

Cetl # (_)_-_ Emails

Gender: f] wate n Female .Date of BirthSTUDENT INFORMATION

1. Social Security number:

2. Residency Status (will be kept confidential):

INS (lmmigration & Naturalization Services)

Resident: A

{6reen card or DBCA # and capy

3. Ethnic Background {check all that apply):flAmerican lndian or Alaska Native

nAsiann glack or African Americanf Hispanic or Latino

nwrriteflPacific lslander or Native Hawaiian

nother:

4, Do you live with?Igoth parents

f] ratherfl Guardian

tlMotherE Foster parent(s)

I Othert Please speciJy

5. Language(s) spoken in your home?nEnglish onlyI English and/or other language(s)

n Please specify

6. Are you married? nyes Itto7. Are you less than 18 years of age and have no parent orguardian? [Yes [ttto

8. Are you homeless or are at risk of becoming homeless?nves Iruo

Statement of lntent to Partidpate: I wish to enroll in and pa.ticipate in th€ activities sponsored byTRio-EduGtional Talent Search. Priorto receiving services, I will provide the staffwith all requestedinformation to verify my eligibilityfor seruices as requir€d bythe U.5. Department of Education(usDE).

Student SignatureIRiOER/UB Revi*d 02115

State_ Zip

-J ---J -.AV|D

student: flyes n *o .u.ro[l:1,:l]'t. t, Si'""t'PARENT/GUARDIAN I N FORMATION

9, Has either biological parent received a 4-year collegedegree?Mother [yes DNo rotiernYes DNo Guordion [Yesnruo

10. Who do you regularly reside with and receive supportfrom? f no*r parents Iuother trrather

nneither parent nother

ll.Do you or your child receive (Check all that apply):I Free/Red uced Lunch I cat-wORx5 (nroc, rnrvr) Socia I

Security fl food Stamps nDisability nUnemployment XOther_12. Family TAXABLE income.(s€e 1o4o bxform,line 43 or roiilrA tax form, lire z7l

I wly family's taxable income from last calendar year federalincome tax return was: S

fJ Vy family did not file a federal income tax return for thelast calendar year. My family's total income from the lastcalendaryear was; 5

I fUy family had no taxable income during the last calendar year.

13. Total number of persons in your family. _(tnctudeyourself)L4. ln case of emergency please contact:

Name Relationship Phone Number

By signing this application, I attest that all the information on this application istrue. Moreover, I authorize the release of the student's official academic recordsto LTCC TRiO-Educational Talent Search, understanding that the information inthese records will be used only to assess the student's need for program services,discern the student's educational progress, evaluate the effectiveness of theprogram activities, and fulfill program-reporting requirements. I also releaseimages of the student to be used for program promotion. I acknowledge andsupport the student's participation on TR|O-ETS programs.

Parent/Legat Guardian Name (print)

City

Date Parent/Legal Guardian Signature Date

TRiO - Education Talent SearchDetermination & Assessment

of Student NEED for project Services

Student Name:(last) (first)

Student's cell number

(middle)

Student id number

What three careers interest you the most?

L.

Do you plan to go to college? n YEs n No [] r DoN'T KNow

Which services do you need in order to prepare for college? Check all thot opply

tr I need information about the benefits of going to college and earning a degree or certificate.tr I need information about how to get ready for college.tr I need information about how I can pay college costs.tr I need help choosing high school courses that will get me ready for college.E I need help choosing college courses.tr I need help completing college admissions applications.tr I need help completing college financial aid application.tr I need help preparing for college entrance examinations.tr I need guidance on how to re-enter high school and earn a diploma or G.E.D.tr I need counseling to help me better understand the career options available for me.tr I need tutoring intr I need to visit college campuses.tr I need a mentor to guide and encourage me as I prepare for college.tr My parents need workshops and counseling to help them better understand the process of preparing for college.

2.

Student signature and date Program director signature and date

ffice use on|

Highest-grade level completed byapplicant et time of entry into project: -D gth D 10th fJ 11th D 12th

Applicant's grade level at time of entrytnto project: n 9th n 10th n lLth I 12th

Does the applicant have potential for aprogramofpost-secondaryeducation nYes nruoor the ability to complete such a program?

ls the applicant currently enrolled in a program of D Yes n Nopost-secondary education?

Does the applicant have limited English proficiency (LEP)? n Yes D ttto

IRiO-ETS,/UB Revised 09/12