Revised 1/23/2020
INCOME VERIFICATION – Please complete questions 1, 2 & 3 as they apply to your household
1. Did your household receive any of the following sources of support in 2019? O Yes O No
O Aid to Families with Dependent Children (AFDC)
O Reduced Lunch at School
O Unemployment Compensation
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2. 2019 Tax Information: THIS INFORMATION MUST BE COMPLETED OR THE APPLICATION CANNOT BE PROCESSED
Please Check here if you DID NOT FILE TAXES O
3. How many people are in the household?
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CERTIFICATION ● RELEASE ● PERMISSION TO PARTICIPATE
• I hereby certify that the household and financial information indicated above is accurate to the best of my knowledge. I hereby authorize the
Wytheville Community College Talent Search to obtain, as needed, the academic records of my son/daughter. The requested records include
school transcripts, attendance records, and assessment test scores. I grant permission for the information to be used to assist in career
planning, college searches, and the college admission process. Parent/Guardian Please Initial:_____
• As part of the WCC Talent Search program, field trips are planned throughout the year. I understand that my child will have the opportunity to
visit museums, educational facilities, career sites and participate in cultural events, and will be chaperoned by Talent Search staff.
Parent/Guardian Please Initial:
_____
•
I understand that the program will meet monthly in a virtual platform. I will encourage my child’s attendance at these meetings and
understand that failure to attend will result in being dropped from the program. Parent/Guardian Please Initial
_____
• I understand that photographs will be taken during the year of students, and I authorize WCC Talent Search to utilize these in promotional
materials if my child’s photo is taken, including online such as a website and Facebook. Parent/Guardian Please Initial:
_____
• My child has my permission to participate in the Wytheville Community College Talent Search Program. Parent/Guardian Please Initial: ____
Applicant’s Name:
Parent/Guardian’s Signature: Date:
WCC Talent Search does not discriminate against students, or applicants on the basis of race, color, sex, handicap, age, national origin, religion, or
political affiliation.
NOTICE: Any person falsifying information stated on this application may be considered in violation of federal laws.
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