Academic Talent Search - Parent Form

Parent/Guardian Information-Eligibility

To comply with U.S. Department of Education regulations, the following is required for program eligibility.

All information is completely confidential.

1Student & Parent Information > 2Specific ATS Information > 3Signature
Student's Full Name
Student's Social Security Number
Student's Date of Birth Student's Date of Birth / MM / DD YYYY
Student's Gender

Student's Gender Male Female
Name of student's school
Student's grade in school
Student's Ethnic Background (select all that apply)

Student's Ethnic Background (select all that apply) American Indian or Alaskan Native Asian White Black or African-American Hispanic or Latino Native Hawaiian or other Pacific Islander
Is the student a United States Citizen?

Is the student a United States Citizen? Yes If no: what is residency status? If no: what is residency status?
Name of first Parent/Guardian
Relationship

Relationship Birth parent Stepparent Foster parent Grandparent Other Other
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home/Cell Phone Home/Cell Phone - ### - ### ####
Email
Name of second Parent/Guardian (if applicable)
Relationship

Relationship Birth parent Stepparent Foster parent Grandparent Other Other
Email
Does this student have siblings that reside with them?

Does this student have siblings that reside with them? Yes No
If so, please list the name and date of birth of those siblings.