Please enable JavaScript in your browser to complete this form. – Step 1 of 5TRiO Talent Search ApplicationIn order for a student to be considered for TRiO Talent Search ALL questions must be answered completely and accurately. A parent/guardian signature is required. Incomplete applications will not be processed. For any questions, please call Dr. Maria Elena Cruz at 818-631-4557.Student InformationName *FirstMiddleLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent Cell Phone *Student Email (e.g. gmail, yahoo, icloud, etc) *EmailConfirm EmailGender (check one) *MaleFemaleDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age *Citizenship *U.S. CitizenNon-U.S. CitizenIf non-U.S. Citizen, have applied for citizenshipStudent Social Security (last 4 numbers) *Ethnic Origin *Hispanic/LatinoWhite, non-Hispanic/LatinoAfrican American/BlackAsianAmerican Indian or Alaska NativeNative Hawaiian/Pacific IslanderTwo or more races, non-HispanicOtherWho do you live with? (check one) *Mother & FatherMother onlyFather onlyGrandparentsOtherIf other, who?Education InformationName of School Attending (2023-24 school year) *Akins Early College High SchoolDobie Middle SchoolEastside Early College High SchoolNavarro Early College High SchoolNortheast Early College High SchoolParedes Middle SchoolGrade *6th grade7th grade8th grade9th grade10th grade11th grade12th gradeStudent I.D. Are you enrolled in another educational program at school?YesNoNo sureIf YES, name of program?(for example, Gear Up, Upward Bound, AVID, etc.)NextFamily InformationMother/Guardian Name *FirstMiddleLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell NumberEmailEmploymentLanguage preferred (e.g., English, Spanish, etc.)Level of Education (highest level completed in the U.S.) *did not complete high schoolgraduated from high schoolgraduated from a technical schoolgraduated from a junior collegegraduated from a 4-year UniversityGraduate Degree (e.g., Master's, PhD, JD, etc.) Father/Guardian InformationFather/Guardian NameFirstMiddleLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell NumberEmailEmploymentLanguage preferred (e.g., English, Spanish, etc.)Level of Education (highest level completed in the U.S.)did not complete high schoolgraduated from high schoolgraduated from a technical schoolgraduated from a junior collegegraduated from a 4-year UniversityGraduate Degree (e.g., Master's, PhD, JD, etc.) Family and Financial Information (To be completed by the parent/guardianNumber of family members/dependents living in household (including yourself) *Is your student receiving Free or Reduced Lunch?YesNoIs your family receiving public assistance?YesNoIf YES, which one (Social Security, Disability, Cal-Works, AFDC)If you filed a 2023 1040 Federal Income Tax Form, please indicate your Taxable Income. THIS IS NOT YOUR ADJUSTED GROSS INCOME. The Taxable Income can be found on IRS Form 1040, Line 43; Form 1040A, Line 27; or 1040Z, Line 6 (check one) The first two pages of Parent(s) Income Tax Statement will be required. *$0 – $21,869$21,870 – $29,579$29,580 – $37,289$37,290 – $44,999$45,000 – $52,709$52,710- $60,419$60,420- $68,129$68,130 – $75,839$75,840 or moreI DID NOT file a 2023 Federal Income Tax Form because my gross income was insufficient to require filing.If no Federal Income Tax was filed for 2023 because the gross income was insufficient to require filing, please check alternative forms of income (check all that apply) Aid to Families with Dependent Children (AFDC)Child SupportWelfare/Social ServicesDisabilityRetirementVeterans BenefitsUnemploymentOtherPreviousNextImage Release FormI ________ give the LNESC Austin Educational Talent Search (ETS) Program permission to use my child's picture/image and or accomplishments as a result of my child's participation in the program. These images/pictures may be used on program brochures, flyers or be published on the program's website and their social media pages. I release any claims against LULAC National Educational Service Centers Inc., the ETS program and or its staff for any damages, awards, claims or liabilities which may arise from any unauthorized use or copyright violations of my child's image, picture of work. *DODO NOTCertificationWe certify that the responses on this form are accurate and complete to the best of our knowledge and that any misrepresentation may be cause for denial or cancellation of admission. We understand that we may be requested to provide income documentation and proof of citizenship if admitted into the LNESC AUSTIN Talent Search program.Student Signature *Clear SignatureDate *Parent/Guardian Signature *Clear SignatureDate *PreviousNextParent Consent for Release of Information between Austin ISD and LULAC National Educational Service Center of AustinStudent NameFirstMiddleLastStudent IDNote: If student ID is unknown, LNESC Austin will obtain ID from AISD’s central officeSchool NameAkins Early College High SchoolDobie Middle SchoolEastside Early College High SchoolNortheast Early College High SchoolNavarro Early College High SchoolParedes Middle SchoolLULAC National Educational Service Center requests your permission to data about your student from Austin ISD for as long as your student is active participant in the program. Participation may include multiple school years. If your student is no longer a participant, access to the data will be removed for LULAC National Educational Service Center. LULAC National Educational Service Center will be granted permission to view your student’s data in Austin ISD’s electronic data system. The following specific data will be viewed by the authorized LULAC National Educational Service Center staff: A. DEMOGRAPHICS – 11-digit TEA identification number, date of birth, age, gender, ethnicity, grade level, AISD enrollment dates, and types of services received, English Language Learner (ELL) flag, retained flag and parent/guardian contact information. B. ATTENDANCE(current and previous school year) – days enrolled, date absent, absence reason and dates tardy. C. GRADES (current and previous school year) – teacher’s names, courses, grades, teacher comments, personal development scores, missing assignments, HS graduation date, HS endorsement track, credits attempted (HS only), credits earned (HS only), class rank (HS only) and cumulative GPA (HS only). D. STANDARDIZED TEST SCORES – District, State and National standardized tests (For example – STAAR, American College Testing (ACT) etc.) Austin ISD and LULAC National Educational Service Center will share information about your student’s attendance in the program with other AISD partners and providers so long as your student is a participant in both programs. Sharing will only occur when AISD has granted the other program or provider authorized access. I understand that the data access will be granted only to the authorized LULAC National Educational Service Center staff. I understand that this data will be used to provide individualized services to my student. Data may also be used, as approved, for the purpose of service tracking, grant reporting and/or program evaluation. No identifying data about my student will be published or distributed to third parties. Any reporting will be done in aggregate. I understand my consent is optional and I may choose to withdraw permission at any time. I understand sharing my student’s data with LULAC National Educational Service Center is not a requirement to participate in LULAC National Educational Service Center’s programs.Parent/Guardian SignatureClear SignatureDate PreviousNextThank you for completing the application. If you have any questions, please email Dr. Maria Elena Cruz at [email protected] or call 818-631-4557. We will follow up within 5 school days of receiving the application. Before clicking the SUBMIT button below, please let us know who referred you to us?FriendTeacherCounselorCounseling CenterFlyer or PosterOtherLastly, do you have a school friend or relative that might be interested in participating with us too? Have them complete the application online! Or give us their name and cell number or email address. We will follow up with them. Updating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.Paragraph TextPreviousSubmit