Thank you for your interest in our Talent Search program! Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.

As a federally-funded grant, we are required to get income information. This information is not shared with anyone else and stays in your student's file.

If you have any questions, please call our office at (208) 792-2913.

Student General Information

First Name *

Middle Name

Last Name *

Date of Birth *

Are you Hispanic or Latino? *

SSN

Gender *

(Check All that apply)*

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Citizenship Type *

Address *

City *

State *

Zip *

Student Cell Phone

Student home phone

Email

Academic Information

Current Grade Level *

Target School *

Family Information

Mother has bachelor's degree *

Father has bachelor's degree *

Number of people in household *

Taxable Income (after deductions) for last year *

I/we did not file taxes last year because income was less than was required to file.

Do you qualify for SNAP benefits? *

Do you qualify for Section 8 housing? *

Does your child qualify for free lunch? *

Mother/Guardian Name *

Mother/Guardian contact number *

Mother/Guardian email

Mother/Guardian occupation

Father/Guardian Name *

Father/Guardian phone number *

Father/Guardian email

Father/Guardian occupation

What do you need to know about going to college? (examples may include study skills, how to pay for college, how to apply, which college to attend) *

Emergency Contact Phone Number

Emergency Contact Name

Information Release: I/we authorize Educational Talent Search (ETS) to obtain documents relative to and consistent with my son/daughter’s education. Such documents may include: a copy of the students school transcript, test scores, ACT/SAT or GED scores, and school lunch program eligibility. I/we authorize ETS to obtain information related to my application for receipt of student financial assistance (federal, state, or other), a copy of my award notification from the financial aid office, and college admission information. I/we authorize ETS to release to or obtain information from any agency or program providing supplemental services. We have answered all the questions on the ETS general application form to the best of our knowledge. We would like to be part of the ETS program. I hereby give my permission for my child to participate in all Educational Talent Search activities. In addition, I hereby give my permission for my child’s name, photograph, work, and/or statements to be used by Educational Talent Search for promotional, publicity, or instructional purposes.

Medical Release: I do hereby grant permission to the Educational Talent Search Program (ETS) of Lewis-Clark State college and its authorized representatives, to furnish first aid as my son/daughter may require, as well as to seek medical attention through the nearest medical facilities when students are on field trips and other authorized activities. This permission is conditioned upon the understanding that in the event of serious illness or the need for hospitalization and/or major surgery, ETS will use all reasonable efforts to contact me. Failure in such efforts should not prevent ETS from providing emergency treatment as may be necessary for the best interest of my child.

FOR ALL PARENTS/GUARDIANS: By electronically signing below, I certify that the information on this form are true, complete and accurate to the best of my knowledge. In addition, I agree to the above-mentioned releases.

Parent/Guardian Signature *

Please select a signature verification type.

Student Signature *

Please select a signature verification type.