Fillable Dear Parent/Legal Guardian, Thank you for your interest (Elgin Community College)

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Dear Parent/Legal Guardian, Thank you for your interest (Elgin Community College)

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Dear Parent/Legal Guardian,
Thank you for your interest in having your student participate in the Talent Search Transition Program!
This is a free college readiness program funded by the U.S. Department of Education. Its purpose is to
encourage students to succeed in school, graduate from high school, and the college of their choice. Our staff
wants to help your child achieve their academic goals!
Some examples of supports your student will receive include:
Access to academic tutoring
Mentoring
Special field trips
Assistance in preparing for college
Assistance exploring future careers
Parent support network
To be considered for the program, please complete the following steps:
1. Download our application packet from www.elgin.edu/talentsearch
2. Parents must complete the application packet.
3. Open the form on your computer to type your responses, please do not print out the forms and fill
them in by hand.
4. Review the application checklist to be sure you included all the required information.
5. After completing the forms, save them to a computer or other storage method.
6. Next, print all pages, and then sign where indicated.
Please bring your completed application packet and copies of each of the following documents in person to our
office at Elgin Community College Talent Search Transition Office, Elgin Community College, Building F,
Room 222.
1. Last completed and signed 1040 tax forms
2. Child’s Birth Certificate
3. Child’s Social Security card
4. Child’s Medical/Insurance card
5. Child’s most recent school transcript
Please note: Because the federal Department of Education funds these services, we need to verify the above
information to confirm that your child and family qualify for the program. This information is confidential and is
not shared.
Our ability to serve students is determined on a first come, first serve basis. It is important to turn in the
application and all the documents as soon as possible. If you have any questions, please contact our office at
847-214-7764 or talentsearchtransition@elgin.edu
Sincerely,
Darlene Harris
Darlene Harris | Director of Talent Search Transition Program
Elgin Community College
1700 Spartan Drive •Bldg. F-222 •Elgin, IL 60123-7193 | : 847.214.6971| Fax: 847 608-5493 :
dharris@elgin.edu
Elgin Community College
Talent Search Transition Program Application Packet/Checklist
Dear Parent or Guardian,
Thank you for your interest in the Elgin Community College Talent Search Transition Program. In
this packet, you will find the documents needed to complete the application process for your
student. Please review and complete each section of the forms. When completed, the forms and
copies of the required documents must be returned in person to Elgin Community College,
1700 Spartan Drive, Building F, Room 222. For your convenience, below is a checklist with
directions for completing the application
Read Talent Search Program Application Letter
Letter provides details about the program’s requirements and services.
Talent Search Application
Section A Complete all requested information in this section.
Section B Check all activities that would help your student succeed in school.
Other – Type in any workshops or activities not listed on the checklist.
Section C This section should be completed accurately and completely.
Be sure to list all necessary information if you check a “Yes” box.
Section D This section should be completed and signed by the Parent/Guardian.
Information must be verified in person with copies of the required
documents.
Section E Parents and students sign and date where indicated.
Section F Parents and students sign and date forms where indicated.
School Release Form
Permission to Share Information Form
Parent/Guardian & Mentor Consent Form
ECC Photographic and Other Mediums Release Form
Complete the form and provide a parent signature.
Parents must sign if student is under 18.
Examples of Required Documents
Birth Certificate
Health Insurance Card
Social Security Card
Copy of IRS Tax Return
School Transcript
To be considered for the 2019-2020 Talent Search Program, return all forms as soon as possible.
If you need assistance or have questions, please email talentsearchtransition@elgin.edu or call
847-214-7764.
________________________________________________________________
Talent Search Transition Program Application
Section A
Student's Last Name
Student's First Name
Student's Middle Name
Gender
Female
Date of Birth (MM/DD/YYYY)
Age
Male
Student's Social Security Number
Student's Personal email Address (NOT school email)
Student's Permanent Address
State
Zip Code
City
Parent/Legal Guardian's First Name
Parent/Legal Guardian's Last Name
State
Zip
Code
Parent/Legal Guardian's Address
Parent's email Address
Student's Phone Number
Parent's Phone Number
Emergency Contact Name 1
Emergency Contact Phone 1
Relationship to Student
Emergency Contact Name 2
Emergency Contact Phone 2
Relationship to Student
Academic Level (Student's high school graduating class and check current year grade level)
High School Class of Current Grade 6 7 8 9
10
11
12
Name of Middle School or High School Currently Attending
Family
College
Attendance
Information
Have e
ither of your parents/guardians completed a 4-year college degree in the United States of America?
Yes
N
o
Ethnic Origin
Please identify your primary racial/ethnic group (select one)
American Indian/Alaskan Native
African American/Black
Asian
Latino/Hispanic
Caucasian/White
Native Hawaiian/Pacific Islander
1
_________________________________________________________________________________
Section B
Needs Assessment
Which Talent Search Program services would meet your needs and help you succeed in school? In your opinion, which
of the following workshops and activities would benefit you the most? Check all that apply.
Learning about my career interests and abilities
Getting good grades in school
Completing and turning in home work on time
Assistance preparing for college
Doing well on tests
Assistance completing college admission applications
Assistance completing financial aid and scholarship applications
Advice and assistance in middle and/or high school class selections
Time management
Reviewing basic math skills
SAT test preparation
Listening in class and asking good questions
Family workshops
Getting along with my teachers
Tutoring
Learning about different careers
Other (please list)
Accepting people who are different from me
Accepting responsibility for my actions
Student Medical History
Section C
Does your child have any of the following?
No
Yes
Physical impairment
If Yes, please list
Yes
No
Medical condition
If Yes, please list
Disability
Yes
No
If Yes, please list
Allergies
Yes
No
If Yes, please list
2
________________________________________
Section D
Family Income Status
The Talent Search Transition Program is funded by the U.S. Department of Education. In accordance with the guidelines
established by the Department of Education, we are requesting the following income information from all participants.
THIS SECTION IS TO BE COMPLETED BY THE PARENT/GUARDIAN
Please indicate the number of members in your household. Include yourself and anyone supported by your household
income.
5 6
8
9
10
4 7
Other
2 3
1
Please
check any of the following that apply to household members.
School free lunch program
Yes
No SNAP
Yes
No
Unemployment
Yes
No
Social Security
Yes
No
Compensation Disability
Food Stamps
Yes
Yes
No
No
Chi
ld Support
Other (ind
icate source)
Yes
No
PLEASE PROVIDE A COPY OF ONE OF THE FOLLOWING DOCUMENTS:
- Social Security/Disability check stub
- Employment W-2 form
- Completed tax form (1040, 1040A, 1040EZ)
- Free school lunch notification
- AFDC verification
I verify that I have read this application and that it is accurate and complete to the best of my knowledge. I
agree to provide
documentation necessary to verify information reported on this form. I understand that the
Talent Search Transition Program
will use the data provided on this form to assist in assessing any academic and /or career planning needs, and that all of
the information will be used in the strictest of confidence. I certify that all information provided is correct to the best of
my knowledge.
Parent/Legal Guardian’s
_____/____/_____
Date
Signature Student’s Signature
________________________________________
Date
_____/____/_____
Student T-Shirt Size
S
XXL
M L XL
FOR OFFICE USE ONLY
Application received from: __Student __Parent __ Counselor Other (please list)_________________
Date Approved:
_____/____/_____
Eligibility: FG
_____
LI
_____
Both
_____
Other
____________________
3
Section E
Contract for Success
If you wish to participate in the Talent Search Transition Program at Elgin Community College, you will be
expected to commit yourself to the following requirements. Please read the statements below. If you understand
that the Talent Search program has a strong commitment to education and is here to help you succeed in school,
please sign on the line provided. Your parent /guardian’s signature is also required.
Student Responsibilities: As a member of the Talent Search Transition Program, I understand that I have been
selected to be a part of this program because I have the potential to attend college. By participating in this
program, I will have the opportunity to reach my educational and career goals. Therefore, I agree to take personal
responsibility for my actions by:
1. Respecting myself, my peers, my parents or guardians, my educators, and my mentors.
2. Adhering to all rules and regulations of Talent Search Transition Program at Elgin Community College.
3. Attending Talent Search activities, being on time, keeping my scheduled appointments and participating in
support services that will help me prepare for my future.
4. Informing my parent(s) or guardians about any Talent Search Transition Program activities that requires their
attendance.
5. Taking appropriate courses in middle and high school to prepare for college, maintaining good grades,
graduating from high school, and applying for college admission and financial aid.
6. Contacting the Talent Search office when I cannot make my commitments to the program.
7. Notifying the Talent Search office if my address, phone, email address, school, and/or grade changes.
Items 8-11 apply to students in Grades 9-12 only
8. Fully participate in the Saturday Transition Academy (TA) by attending at least 80 percent of the required
monthly Saturday TA meetings.
9. Meeting with my assigned mentor on TA Saturdays.
10. If I fail to participate in these meetings, I know that I will not be allowed to attend college visits or field trips.
11. Acknowledging that if I do not participate in the required monthly Saturday TA meetings, I will remain a part
of the Talent Search program, but will be removed from the Saturday Transition Academy.
Student’s Signature
_____________________________
Date
_____/____/_____
Parent/Legal Guardian Responsibilities: I understand and agree that the goal of the Talent Search Transition
program is to assist my child in graduating high school and achieving his/her college or career goals. I agree to:
1. Monitor my child’s participation in the Talent Search program; when required, drop off and pick up my child
at the scheduled time; return forms in a timely fashion; and attend Talent Search activities and meetings to
support my child.
2. Communicate with the Talent Search office about my child’s involvement in the program and his/her
academic progress.
3. Notify the Talent Search office if my address, phone, email address, and/or school changes.
_________________________________
Date
_____/____/_____
Parent/Legal Guardian’s Signature
4
Section F
Elgin Community College
Talent Search Transition Program
School Release Form
I. I hereby give permission to the appropriate office of
Middle School or High School Name
to issue a transcript for:
Student's ID Number
Student's First and Last Name
II. Permission is hereby authorized to ECC Talent Search Transition Program to release or request information
from authorized official to maintain my educational records.
Student’s Signature _____________________________________
Date
_____/____/_____
_____/____/_____
Parent/Legal Guardian’s Signature _________________________
Date
5
Elgin Community College
Talent Search Transition Program
Permission to Share Information Form
Student’s First and Last Name
To meet guidelines set by FERPA for the sharing of student information, the Talent Search Transition Program at
Elgin Community College requires a signed document with the signatures of both the student and the
parents/guardians agreeing to the following:
(School Name) and Elgin Community College will share all information
necessary for the admission, enrollment, and progress of students that are enrolled in the Talent Search
Transition Program at Elgin Community College.
Communications are “limited” to the sharing of information between the Talent Transition Program
administration, faculty, and staff at Elgin Community College and the counseling, administration, faculty,
and staff at the high school.
As per Elgin Community College policy, instructors and/or other ECC staff are permitted to share
information with the student only and not with parents/guardians or other individuals.
Both the student's and parents/guardian's signatures are required.
Student's Signature
______________________________________
_____/____/_____
Date
Parent/Legal
Guardian’s
Signature
__________________________
_____/____/_____
Date
6
Elgin Community College
Talent Search Transition Program
Mentor Consent Form
I, the parent or legalguardian for (Student’s Name) hereby give my permission
for my child to participate in the Talent Search Transition Program at Elgin Community College (ECC).
I fully understand that the program involves mentors, who shall be selected from the college and the community. I also
understand that the volunteer mentors will be screened (including a criminal background check) and trained before
beginning in the program. A mentor will be expected to spend a minimum of one hour per month with my child on-site at
Elgin Community College and may include at least one contact per
week via email or by telephone. The mentor is not allowed to take or meet my child beyond the college campus.
I understand that my child will participate in an orientation session on campus which will explain the Talent Search
Transition Program’s mentor to mentee expectations.
I understand that during the course of the mentoring program there may be special group events
(incorporating all mentors and mentees). I understand that the staff of the Talent Search Transition Program will provide
ongoing monitoring of the mentoring activities.
Parent/Legal Guardian’s Signature _____________________________
__________________________
Date
_____/____/_____
_____/____/_____
Parent/Legal Guardian’s
Printed
Name
Date
7
__
PHOTOGRAPHIC and OTHER MEDIUMS RELEASE
I do hereby irrevocably authorize, the Board of Trustees for Community College District No. 509, commonly known as
Elgin Community College, its officers, employees, agents, successors, assigns and those acting under its permission
and with its authority, to copyright, publish, duplicate, or otherwise use, disseminate, and/or dispose of, for art,
advertising, information, educational purposes, trade, or any other lawful purpose whatsoever, any medium, including
but not limited to, photographic pictures, digital images or recordings, DVD’s, videotapes, software, website entries,
sound recordings of me or in which I may be included in whole or in part, or composite or distorted in character or
form, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through
any medium and taken at any location of Elgin Community College or any production location determined by Elgin
Community College.
I do hereby waive any right to inspect or approve the finished product or advertising or other copy that may be used
in conjunction therewith or the use to which it may be applied now or in the future. I also hereby waive any right to
royalties or other compensation from the Board of Trustees for Community College District No. 509, commonly known
as Elgin Community College, its officers, employees, agents, successors and assigns.
I hereby agree to hold harmless, release and discharge the Board of Trustees for Community College District No. 509,
its officers, employees, agents, successors, assigns and all persons acting under its permission or authority, including
any firm publishing and/or distributing the finished product in whole or in part, whether on paper, via electronic
media, on web sites, or some other format from and against any and all claims, demands, damages or liability,
including
reasonable attorneys’ fees and court costs which I may have, arising from or related to the use of any photographic
pictures, digital images or recordings, DVD’s, videotapes, software, website entries, sound recordings of me or any
other medium, including but not limited to any misuse, by virtue of any blurring, distortion, alteration, optical illusion,
or use in composite form whether intentional or otherwise, that may occur or be produced in the taking, processing,
reduction or production and completion of the pictures, or in any processing tending toward the completion of the
finished product, its publication or distribution. I understand that this Release binds my heirs, executors,
administrators, and assigns, as well as myself.
I do hereby certify that I am of legal age (18 years or older) and I am competent to contract in my own name in the
above regard I have read this release before signing below, and I fully understand the contents, meaning and impact
of this release. I understand that if for any extraordinary reason my privacy must be protected after the submission of
this document, I must notify Elgin Community College in writing. I further understand that my failure to do so will be
interpreted as a free and knowledgeable acceptance of the terms of this release.
(Signature) (Printed Name) (Date)
If the person signing is under age 18, consent must be given by a parent or legal guardian as follows:
I, the undersigned, hereby certify that I am the parent and next best friend or legalguardian of ___
(Print Minor’s Name)
I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I
do hereby agree to the terms in this release and give my consent without reservation to the foregoing on behalf of the
above named minor. I understand that if for any extraordinary reason the privacy of said minor, must be protected after
the submission of this document, I must notify Elgin Community College in writing. I further understand that my failure
to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
(Parent/Legal Guardian’s Signature) (Parent/Legal Guardian’s Printed Name) (Date)
8
Examples of Required Documents
Birth Certification
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Social Security Card
Elgin Community College
Talent Search Transition Program
Copy of Latest IRS Tax Return
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9
Example of High School Transcript
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Do
e, Jesus
 
  
  
10
mple of Middle School nscript


s
b
ll


 







03 


0





4







2



8






Q
1
Q2

Q3

Q4



C
B


B B


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  




 
 












 










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Dear ParentLegal Guardian, Thank you for your interest (Elgin Community College)

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Completed 25 July 2020

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