Chemeketa TRIO Talent Search Application

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. 
Did anyone refer you to TRIO? If so, please list their name here:

Student Information:
First Name *
Last Name *
Middle Name
Date of Birth *
Gender *
Gender Identity
Race/Ethnicity *
Address *
Address 2
City *
State *
Zip *
Phone *
Student Cell Phone
Email *
Residency Status of Student *

Academic Information:
Describe your primary reason for applying
Current Grade Level *
Current School *
Student ID Number *
Current Age *

Family Information:
Parent Name *
Parent /Guardian Phone Number *
Has either parent/guardian completed a 4-year Bachelor's degree? *
Household Income Range *
How many people in your household? *

Student and Parent Agreement
I hereby authorize TRIO Talent Search staff  to request my academic student records from my high school and/or school district (transcripts, schedules, test scores, etc.).  I give my son/daughter permission to participate in TRIO Talent Search meetings and activities. I also give permission for my son/daughter to be interviewed, photographed or videotaped by TRIO for use in program promotional materials and documentation. Our signatures below indicate our commitment to the TRIO Talent Search Student and Parent Agreement. To the best of our knowledge, all the information we have provided in this application is true.

Sign and Submit:
Student Signature *
Please select a signature verification type.
Parent/Guardian Signature *
Please select a signature verification type.