Academic Talent Search - Student Interest

Name Name First Last
Birthdate Birthdate / MM / DD YYYY
Gender

Gender Male Female
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Name of School
Grade in School
What grades do you usually earn? (choose all that apply)

What grades do you usually earn? (choose all that apply) A's B's C's D's
What are some things you would like some help with this year? (choose all that apply)

What are some things you would like some help with this year? (choose all that apply) Study Skills/Test Taking Academic Coaching Setting goals and reaching them Career Exploration
What do you see yourself doing after you graduate from high school (choose one)

What do you see yourself doing after you graduate from high school (choose one) Attending a college or university Joining the military Attending a vocational or technical school (e.g. welding, electrician, plumbing, etc.) I'm not sure
Tell us who the parent(s)/guardian(s) are in your home so we can share your interest in ATS! (include names)
I understand that ATS may need information from my school. I understand that if I want to be eligible to participate in special activities (e.g. field trips), I must attend ATS in-school activities and maintain a grade point average of at least 2.25 (C average).

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY