Thank you for your interest in our Educational Talent Search program! TRIO Educational Talent Search is a federally funded grant by the Department of Education and must document student eligibility. All information requested is for this purpose and will be kept strictly confidential.

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. If you have any questions, please call our office at 708-974-5648.

Student Information:
First Name *
Last Name *
Date of Birth (mm/dd/yyyy) *
Phone Number *
Street Address
City *
Zip Code *
Student Email *
Current School *
Grade *
For middle school students - What high school do you plan to attend?
Gender *
English is my *
Are you in a Bilingual or ESL Program? *
I am a *
My Alien Registration Number is
Ethnic Origin *
Are you enrolled in Upward Bound, Upward Bound Math/Science or Gear Up? *

Self-Assessment:
List three careers you are interested in learning more about - Please use one line per career. *
List three colleges you would like to visit - Please use one line per college. *
What academic goals would you like to achieve? *
Which of these would you like assistance with to help you accomplish your goals? (Check all that apply.)
Career Counseling
ACT Test Preparation
Selecting a College/University
Test-Taking Tips
GED Assistance
Returning to College
Self-Esteem Building
High School Graduation Requirements
Financial Aid Information
College Planning
Goal Setting
Resume Writing
Study Skills
College Prep Curriculum
Scholarship Search Assistance
Selecting a Major in College
Tutoring
If help with Tutoring is one of your selections, specify the subjects you Tutor - Please use one line per subject.

Student’s Commitment:

Your signature will indicate that you have read, understood, authorized, and agreed to each of the items listed below.

I agree to do the following:

• Attend school regularly, refrain from discipline/behavioral problems, and strive to earn high grades in all classes.

• Contact my ETS Specialist if there is a change in class schedule and/or home address or phone number.

• Seek help with academic and/or personal problems if needed.

• Take advantage of special program activities such as college visits, financial aid workshops, and cultural events.

• Work toward promotion to the next grade each year in the program.

• Apply for financial aid during my senior year using the Free Application for Federal Student Aid Application.

• I, the student applicant, am interested in actively participating in Moraine Valley Community College’s Educational Talent Search (ETS) activities, and I understand that if I, the student applicant, act at any time inappropriately or cause any type of damage while participating in an ETS activity, my parent/guardian will be contacted and/or my parent/guardian may be charged for any damages and/or expenses.

• I understand that the information provided on this application will be held in confidence by the ETS staff.

• I certify that the information provided on this application is true and correct to the best of my knowledge.

Your signature indicates your understanding, agreement and authorization of the items listed above.
Student's Signature *
Please select a signature verification type.

Parent/Guardian Information:

Must be filled out by Parent or Guardian
Father/Stepfather/Male Guardian’s First and Last Name
Father/Stepfather/Male Guardian’s Email
Father/Stepfather/Male Guardian’s Preferred Language
Father/Stepfather/Male Guardian Highest Level of Education Completed
Mother/Stepmother/Female Guardian’s First and Last
Mother/Stepmother/Female Guardian’s Email
Mother/Stepmother/Female Guardian’s Preferred Language
Mother/Stepmother/Female Guardian’s Highest Level of Education

Reference your most recently completed tax form for taxable income: 1040 (line 43), 1040A (line27) or 1040EZ (line 6).
How many people are in your family? *
Annual Taxable Income *

Please check any of the following that apply to household members:
Free & Reduced Lunch
Unemployment
Disability Compensation
SNAP
Social Security
Child Support
Other
If you selected Other, please specify here

Please check all of the services that you would like your child to receive.
Career Counseling
Career Counseling
GED Assistance
ACT Test Preparation
Scholarship Search
High school Graduation Requirements
Self-Esteem
College Planning
College Prep Curriculum
Study Skills
Financial Aid Information
Tutoring
If help with Tutoring is one of your selections, specify the subjects you Tutor - Please use one line per subject.
How did you hear about Moraine Valley’s Educational Talent Search Program? *

Parent/Guardian Commitment:

Your signature will indicate that you have read, understood, authorized, and agreed to each of the items listed below.
Students over 18 do not have to complete this section.

I authorize Moraine Valley’s Educational Talent Search to:

• Request a copy of my child’s academic transcripts from his/her school.

• Request a copy of my child’s Free Application for Federal Student Aid (FAFSA) letter and/or a copy of his/her college or university’s financial aid award letter.

• Request a copy of my child’s free or reduced lunch information from his/her school.

• Request a copy of my child’s test score reports, such as ACT, PSAT, SAT, LSAT, AFSSA, and other materials necessary for participation in the Educational Talent Search Program.

• Provide college representatives and prospective employers with my child’s name and address for the express purpose of providing information to him/her about college and work opportunities.

• Use my daughter’s/son’s image for promotional material, such as for advertising, promotional videos, publications, schedules, catalogs, web pages, annual reports, recruiting presentations, and viewbooks, among other methods of communication.

• I understand that if my child needs accommodation for a disability to participate in the Educational Talent Search Program or in any of its scheduled activities, I must contact the director of Educational Talent Search at (708) 608-4025 (in Spanish at (708) 608-4028) at least 30 working days prior to the activity.

• I, the parent/guardian am interested in having my child actively participate in Moraine Valley Community College’s
Educational Talent Search activities, and I understand that if my child acts at any time inappropriately or causes any type of damage while participating in an Educational Talent Search activity, I will be contacted and will take charge of any damages and/or expenses.

• I understand that the information provided on this application will be held in confidence by the Educational Talent Search staff.

• I certify that the information provided on this application is true and correct to the best of my knowledge.

Your signature indicates your understanding, agreement and authorization of the items listed above.
Parent/Guardian’s Signature *
Please select a signature verification type.

Video and Photography Release

In consideration of my engagement as a model by Moraine Valley Community College (MVCC), I hereby give MVCC, its legal representatives and assigns, those for whom MVCC is acting, and those acting with its permissions, or its employees, the right and permission to copyright and/or use, reuse and/or publish, and republish photographic and video pictures or portraits of me, or in which I may be distorted in character, or form, in conjunction with my own or a fictitious name, on reproductions thereof in color, or black and white made through any media by MVCC, including the use of any printed or electronic matter in conjunction with this use.

I hereby waive any right to inspect or approve the finished photograph, video, or advertising copy, or printed or electronic matter that may be used by MVCC or to the eventual use that it might be applied.

I hereby release, discharge and agree to save harmless MVCC, its representatives, assigns, employees or any person or persons, corporation or corporations, acting under its permission or authority, or any person or persons, corporation or corporations, for whom he/she might be acting, including any firm publishing and/or distributing the finished product, in whole or in part, from and against any liability as a result of any distorting, blurring, or alteration, optical illusion, or use in composite form, whether intentionally or otherwise, that may occur or be produced in the taking, processing or reproduction of the finished product, its publication or distribution of the
same.

I hereby warrant that I am 18 years of age or older, and competent to contract in my own name as far as the above is concerned.

I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof.
Full Name *
Signature *
Please select a signature verification type.
Witness Name

Upload Documents

This section is for students to upload any important documents that they may have {List most common documents for upload}. Please keep in mind, each upload section only allows for one document to be uploaded.

If you accidentally select the incorrect document and need to remove/replace that document, do the following:

  1. Select Choose File - Which will opens up a window to select another document.
  2. To replace, navigate to the location of the correct file, then select the document for upload.
  3. To completely remove a document, select Cancel and the document you previously selected will be removed.
Upload Document Here