Directions: This application should be completed by a parent/legal guardian. Applications are only considered complete when all questions on this application have been completed and this form has been signed by both the parent/legal guardian and the student applicant. Please note that questions regarding an applicant’s race, ethnicity or language are purely for statistical tracking required by the U.S. Department of Education, and are not considered when determining an applicant’s eligibility for services. By signing this document you verify the truth and accuracy of the information provided. To expedite the processing of your application you may also submit this form with a copy of your most recent transcript.

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A. STUDENT APPLICANT'S INFORMATION
First Name *
Last Name *
Gender *
Date of Birth *
Current Age *
Current School *
Current Grade Level *
How did you here about the ETS Program?
Do you receive services from other pre-college programs (UB, Other College Prep Programs )? *
Ethnicity *
Are you enrolled in LOTE Courses? *
If Yes, what is your native language
Citizenship *
If you are a U.S. Permanent Resident (Green Card Holder) please provide Alien Registration Number
How many people are in your household, including yourself? *
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B. PRIMARY STUDENT CONTACT INFORMATION
Student's Mailing Address (Address, City, State, Zip Code, and Country):
Student's Home Phone *
Student's Mobile Phone *
Student's Email Address *
Emergency Contact Person (Full Name) *
Relationship to Emergency Contact Person *
Emergency Contact Home Phone *
Emergency Contact Mobile Phone *
Emergency Contact Email Address *
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C. PARENT INFORMATION
Additional documentation may be requested to verify program eligibility unless adequate documentation of income status is provided. 
The student applicant regularly resides with and receives support from *
If other, please specify
Mother/Legal Guardian Name *
Mobile Number *
Work Number *
Email Address *
Highest Education Completed
Father/Legal Guardian Name *
Mobile Number *
Work Number *
Email Address *
Highest Education Completed *
Did you file 2021 taxes? *
If you put YES, please provide taxable income (1040 line 15) *
If you put NO, please provide total 2021 income (If no income was earned, put zero) *
Do you currently receive any public assistance for low/no-income households?
SNAP (Food Stamps)
Medicaid
Section 8
Other
If other, please specify
________________________________________________________________________________
 D. PARENT/LEGAL GUARDIAN-STUDENT CONTRACT

I, and my child,  agree that if accepted into the Educational Talent Search (ETS) Program, I will encourage my child to adhere to the following responsibilities. Furthermore, should my child not attempt to carry out the goals set forth in this agreement, and thereby experience an unsuccessful academic semester or year (semester or cumulative GPA falling below a 2.0 or 70%) my child understands that they will be academically dismissed from the ETS Program.

1. Strive continually to improve grades and maintain at least a 2.0 GPA to ensure academic success while in ETS. (i.e. Attend all classes to complete and submit all homework, class assignments, test, quizzes, exams, and/or projects to school teacher.)
2. Remain an active participant in the ETS Program throughout middle school and high school by attending and participating in scheduled ETS meetings, sessions, workshops, activities, and/or recommended tutoring sessions.
3. Follow the instructions and complete required documentations while participating in ETS activities and traveling on official ETS approved field trips.
4. Graduate from high school, communicate with ETS staff about educational goals, and enroll at a post-secondary institution by the fall semester immediately after high school graduation.
5. Provide follow-up information to the ETS Program concerning my success in obtaining a post-secondary degree.
6. Notify ETS of any changes with contact information, mailing address, and/or school if transferring.
 
As a parent, I also adhere to these responsibilities:

1. I will encourage my child to attend and participate in scheduled meetings, sessions, workshops, and activities.
2. I will be my child's transportation in scheduled winter, spring, summer workshops, or appointments.
3. I will communicate with ETS staff about his/her educational opportunities.
4. I will notify ETS of any changes with contact information, mailing address, and/or school if transferring.

Parent/Legal Guardian Certification: I represent that I have read and understand the foregoing statements and I am competent and hold the legal authority to execute this agreement. I certify that the information provided on this application is true and correct. Furthermore, I consent to the ETS authorizations and releases on this form and understand that it will remain in effect even after my child has exited the ETS program. By signing this document, I agree to my child's participation in the ETS Program. Similarly, by signing this form, the student applicant also agrees to his/her participation in the program and consents to any future ETS tracking for the purpose of annual performance reporting.

PLEASE WAIT FOR YOUR SIGNATURE TO BE ACCEPTED BEFORE MOVING ON.

Student Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Legal Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
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E. AUTHORIZATION & RELEASE

The personal information that you give to the University of Guam (herein referred to as UOG), TRiO Programs, and Educational Talent Search Program (herein referred to as ETS) is for the U.S. Department of Education (US ED). This information is protected by the Privacy Act of 1974. No one may see the information unless they work with or for UOG TRiO Programs and ETS or are specifically authorized to see it. The information is necessary to determine if your child is eligible to participate in ETS and helps the US ED to measure his/her success. The US ED has the authority to gather such information (20 USC § 123 la). Your child is not eligible for any services from ETS unless the information is given and the form is signed.

 I. School Records: I authorize my child's school and any and all future secondary and postsecondary institutions to release school records to the UOG's TRiO Programs and ETS. I understand that school records released to the TRiO Program and ETS may include but are not limited to: transcripts, report cards, standardized test scores, Individual Educational Plans, college registration and enrollment status, and financial aid information. I understand that this release is validated upon signing this form and that records will be attained for the purpose of ETS eligibility verification, student assessment, student services, evaluation, and secondary and postsecondary tracking for annual performance reporting purposes.

ll. Waiver of Liability: I release UOG TRiO Programs, ETS, and any and all employees or volunteers of the above institutions and programs from any and all liability resulting from any accidents, injuries, cost or loss of property and life which may occur.

lll. Data-Sharing Release: I consent to disclose my child's participation in other federally funded pre-college programs in order to prevent the duplication of services. I authorize UOG TRiO Programs and ETS to obtain, verify and share my child's participation and service information with any agencies/programs as deemed necessary for my child's participation in UOG TRiO Programs and ETS. This authorization includes, but is not limited to, obtaining and/or sharing documents with the other TRiO programs and other current or future College Preparatory Programs for the purpose of reporting and coordinating services for my child and for statistical data gathering required by US ED. The documents and information obtained and/or shared may include verifications of participation, services received, and other relevant applicant information and school records.

Parent/Legal Guardian Certification: I hereby release Educational Talent Search (ETS), its host institution UOG, ETS employees, ETS Director, ETS guest speakers, from all claims and demands arising out of, or in connection with, any use of said "Materials" including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights. I acknowledge and agree that no sums whatsoever will be due to me because of the use of the "Materials" or any rights therein.  

PLEASE WAIT FOR YOUR SIGNATURE TO BE ACCEPTED BEFORE MOVING ON.

Student Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Legal Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
________________________________________________________________________________
F. WEBSITE & SOCIAL MEDIA RELEASE 

Educational Talent Search (ETS) is expanding its form of communication by including several social media outlets. As such, we are asking permission to communicate via social media. There will be occasions where ETS will need to document and release information concerning his/her work, participation in activities, and/or academic and athletic achievements. ETS will also be contacting your child via social media outlets for upcoming events and activities in the program. The purpose of the "Website & Social Media Release" is to request your permission, in advance, to allow information about your son/daughter and his/her school related work, activities, events, and athletic achievements to be released by ETS through our social media outlets, such as but not limited to the following: Facebook, Twitter, Instagram, YouTube, Whatsapp, Zoom and other social media outlets we plan to use in the future.

Such information may include some or all of the following:

  • A photograph or video recording of your son/daughter participating in an ETS, school, or TRiO event
  • His/her first and last name, age, grade level, and the name of the school he/she attends
  • Information about your son/daughter's school work, activities, academic achievements and/or athletic achievements * Examples of your son/daughter's school work, activities, academic achievements and/or athletic achievements
  • Social media contact information ( used only for contacting purposes by ETS staff for reminders and updates). 

PLEASE CHECK MARK "I GRANT PERMISSION" OR " I DO NOT GRANT PERMISSION" BELOW:

I GRANT PERMISSION for ETS to post my child's photo, school work and/or school activities and events, academic and/or athletic achievements and contacts to be released by ETS through its social media outlets as stated in the list of examples above. We kindly request for the following information.
Whatsapp Number
Facebook
Instagram
Twitter
I DO NOT GRANT PERMISSION for ETS to post my child's photo, school work and/or school activities and events, academic and/or athletic achievements and contacts to be released by ETS through its social media outlets as stated in the list of examples above.

Parent/Legal Guardian Certification: I hereby release Educational Talent Search (ETS), its host institution UOG, ETS employees, ETS Director, ETS guest speakers, from all claims and demands arising out of, or in connection with, any use of said "Materials" including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights. I acknowledge and agree that no sums whatsoever will be due to me because of the use of the "Materials" or any rights therein. 

PLEASE WAIT FOR YOUR SIGNATURE TO BE ACCEPTED BEFORE MOVING ON.

Student Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Legal Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
________________________________________________________________________________

G. EIGHTH GRADE SURVEY & NEED FOR THE PROGRAM

TO BE COMPLETED BY 8TH GRADE STUDENTS ONLY (IF YOU ARE A HIGH SCHOOL STUDENT, SKIP SECTION G AND GO TO SECTION H)

ETS is a pre-college preparatory program that provides free information, assistance, and encouragement to college-bound students. The survey below will help ETS staff identify qualified youth with potential for education at the postsecondary level. 

Do you know the requirements for graduating from high school?
Do you know what service learning is?
Do you know the difference between a community college and a four year university?
Do you know what financial aid is?
Do you know what a scholarship is?
Have you talked to your parent(s) about your plans after graduating from high school?
Do you know what are PSAT, SAT, ACT, AP, and Honors is?
Why do you want to be in UOG's ETS Program? (Choose all that apply) 
I want to get information and assistance in transitioning into high school.
I am interested in learning about college and my educational opportunities.
I want to get information and assistance in financial budgeting.
I am currently failing my classes and would like to connect to tutors.
Other
If other, please specify
What services are you interested in? (Choose all that apply)
Information and assistance with completing middle school.
Information and assistance with my high school transition.
Information and assistance with career exploration.
Summer Bridge Program at the University of Guam.
Other
If other, please specify
Academic Information 
What are your favorite subject(s) and activities in school?
What subject(s) do you need tutoring with, if any? (If you do not need tutoring put none)
Who is your school counselor?
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H. HIGH SCHOOL COLLEGE BOUND SURVEY & NEED FOR THE PROGRAM

TO BE COMPLETED BY 9TH - 12TH GRADE STUDENTS ONLY (IF YOU ARE AN 8TH GRADER SKIP TO SUBMIT APPLICATION)

Are you planning to attend a four year university?
Are you considering off-island schools for college?
Are you considering alternatives to college? (i.e. military, community college)
Have you talked to your family about your college options?
Have you discussed the cost of attendance with your family?