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1 ATTENTION STUDENTS! I ncludes College Trip, College Prep Workshops AND SAT Prep Course. Friday, January 25 th through Saturday, March 23 rd Sponsored by the EDUCATIONAL TALENT SEARCH PROGRAM at JOHN JAY COLLEGE. *To participate students must be active members of the Educational Talent Search Program at John Jay College and must be able to commit to the full course schedule. To Register: Contact an ETS counselor at (212) or the program offices at Remember, enrollment is firstcome first served based on your COMPLETE registration. Preference will be given to first timers! SPACE IS LIMITED so begin your registration today! Educational Talent Search Program at John Jay College 619 W. 54th Street 7th Fl.

2 COLLEGE/SAT PREP Calendar Important Dates Spring 2013 Course: January 25 - March 23, 2013 MONTH M T W R F s s JANUARY January 25: Parent/Student Orientation & Financial Literacy Workshop :30p-7:30p January 26: College ToolKit/College Prep 9a - 2p* FEBRUARY February 2: SAT Pre-Test 9a - 2p February 7: College Trip February 9, 16: College Prep/SAT Classes 9a - 2p February 23: National TRIO Day No SAT Classes MARCH March 2,9,16,23: College Prep/SAT Classes, 9a - 2p March 23: SAT Post-Test 9a - 2p X * All College/SAT Prep participants are required to take the SAT PRE & POST Tests & attend the scheduled College ToolKit training workshop. If you have a conflict with any of the dates above, please notify your ETS counselor PRIOR to registration!!! 619 W. 54th Street, 7th Floor NY, NY Tel Fax

3 PROGRAM FACT SHEET 619 W. 54th Street, 7th Fl OUR MISSION The Educational Talent Search Program is a counseling, college, and career services program designed to prepare students for higher education. It is funded by the U.S. Department of Education and sponsored by John Jay College of Criminal Justice. This Program aims to provide potential first generation college students from low-income families with information, counseling, and tutorial services which will encourage them to achieve in, or reenter, and graduate from secondary schools. Our goal is to increase the enrollment of our students in post-secondary educational programs. PROGRAM SERVICES Information on admission to colleges, universities, and other post secondary schools/training programs. Mentoring & Advisement on personal, career and academic decisions. Financial Aid information on college scholarships, grants, loans, and assistance in completing financial aid forms. Workshops on resumé writing, test taking techniques, study skills, choosing the right school, etc. We also hold workshops for your parents designed to help them help you better. And we offer SAT Prep workshops. Tutoring in academic subjects. Trips to public and private schools: High Schools will visit 2-year & 4-year colleges, business, trade, and technical schools; Middle Schools will visit NYC High Schools. Cultural Activities to enhance your educational and personal development. ELIGIBILITY REQUIREMENTS To become a part of our program, participants must meet certain requirements. Potential participants are eligible: If they are at least 11 years old and younger than 27 years old If they come from families with incomes under $34,575 (for a family of 4) Where neither parent has graduated from college. Potential participants who do not meet these requirements are encouraged to apply since we also provide a need-based service. Talent Search Alumni have recently been admitted to the following colleges: Albany University Alfred University Babson College Barnard College Baruch College Binghamton University Boston University Brooklyn College City Tech College of Mt. St. Vincent Fordham University Howard University Hunter College John Jay College LaGuardia CC Penn State Purchase College Queens College Skidmore College St. John s University and many

4 Rev. 12/11/12 Program Application (1 of 4) 619 W. 54th Street, 7th Floor Application Checklist: 1.0 Student Information Fill in this section for the applicant. Information in this section: helps to determine need for the program and provides us with information needed for U.S. Government reporting. 2.0 Family Information Fill in this section for the parent(s)/guardian(s) with whom the applicant lives. Information in this section helps to determine 1 st generation college-bound student status. 3.0 Income Please fill in this section as accurately as possible. Remember to enclose the appropriate documentation. Information in this section is important in determining applicant s eligibility for the program. 4.0 Permission Statements Parent/Guardian Signature AND Student Signature is required here to allow applicant s enrollment and participation in the program and to authorize the release of all junior high, high school, college transcripts, and other pertinent information regarding the student s academic status for record-keeping and tracking purposes. The following statement permits photographing/recording at Talent Search events and their use in program publications and informational materials. 1.0 STUDENT INFORMATION Name: Home Address: Last First Middle Initial Number Street Apartment # Sex: M F City: State: Zip Code: Home Phone #: ( ) - Emergency Contact: Relation: Emergency No: ( ) - Social Security #: - - Age: Birth / / Birth Place: Student s Alternate CITIZENSHIP (Please, check one.) U.S. Citizen An Alien, lawfully admitted for permanent residence. Alien card #: A 1.2 RACE/ETHNICITY: (Please, check all that apply.) American Indian Asian African American Hispanic White Other FOR PROGRAM USE ONLY (Do not fill out.) Yr. Admitted: School: Grade: Counselor:

5 Program Application (2 of 4) 619 W. 54th Street, 7th Floor 1.3 EDUCATION STATUS What school do you attend now? What grade are you in now? Are you eligible to receive free lunch in school? Yes. No. Did you graduate from high school? Did you get a G.E.D.? Did you earn any college credit(s)? Yes. No. If yes, which high school? Yes. No. Yes. No. If yes, how many hours? Are you interested in completing: (Check one.) a College Degree? Vocational/Technical Training? Are you currently enrolled in any of the following programs? (Check all that apply.) Educational Talent Search Upward Bound Student Support Services Liberty Partnership GEAR UP Educational Opportunity Centers Other federally funded program Which of the following educational services do you need assistance in? (Check all that apply.) College Prep College Tours Financial Aid SAT Prep Tutoring Scholarships Academic Counseling Cultural Activities Career Advisement Workshops Others Are you currently enrolled in a rigorous academic course(s) outside of your school? Yes. If yes, please explain how the course(s) are paid for: No. Are you enrolled in a rigorous program of study at your school (i.e Advanced Placement courses, Honors courses, 1+ years of a foreign language course)? Yes. No. Test(s) taken within the last year: PSAT SAT ACT Other If yes, when? And what was your score? Math Verbal Writing Do you plan to attend college in NY State? Yes. No. What is your desired major?

6 Program Application (3 of 4) 619 W. 54th Street, 7th Floor 2.0 FAMILY INFORMATION Please complete the following information for the parent(s)/guardian(s) with whom the applicant lives. Father/Guardian s Name:, Did he complete four years of college and receive a Bachelor of Arts/Bachelor of Science degree? Yes. No. Mother/Guardian s Name:, Last First Middle Initial Last First Middle Initial Did she complete four years of college and receive a Bachelor of Arts/Bachelor of Science degree? Yes. No. Parent s Name 3.0 INCOME For verification of income you MUST submit one of the following: (Please, choose one.) How many persons are in your household? Check your appropriate household income: $16,000 or below between $16,000-$20,000 between $20,000-$27,000 between $27,000-33,000 between $33,000-$38,000 between $38,000-$44,000 between $44,000-$49,000 above $49, INCOME VERIFICATION Source of Income: Employment Social Security Insurance (SSI) Public Assistance Other Documentation Required: Copy of parent s most recent Income Tax Form (1040) Note: Please be sure that the copy is signed by the parent/guardian. Copy of Award Letter from Social Security Office Copy of the Budget Sheet/Letter from the Human Resources Administration Signed Statement Note: See section 3.2 below. 3.2 SIGNED STATEMENT Please Note: This form may be used in place of the 1040 or 1040a should that tax document not be available. This form may be used in lieu of copies of award letters from public assistance, social security, veteran s benefits or other types of benefits received by the applicant or the applicant s family to document financial need. (OVER)

7 Program Application (4 of 4) 619 W. 54th Street, 7th Floor I hereby state that during the previous tax year, January 1st through December 31st, 2012 my family s total income was $ Indicate total number of dependents: Source of Income: Employment Public Assistance Social Security Insurance (SSI) Other Signature: Social Security #: PERMISSION STATEMENTS I, and my child Name of Parent/Guardian Child s Name certify that all the information provided on this application is true and correct and will be kept confidential. I/we authorize my child s school to release records (junior high, high school, and college transcripts, and other pertinent information regarding my child s/my academic status for record keeping purposes. I/we authorize the release and exchange of my child s financial aid information from colleges and federal government to ETS. He/she may also participate in program activities such as vocational/career assessments, workshops, tutoring and counseling. He/she may join trips to colleges/universities, and attend career and cultural events Student s Signature: Parent s/guardian s Signature: 4.1 PERMISSION FOR PHOTOGRAPHING, RECORDING AND USAGE I,, hereby consent to the participation in interviews, the use of quotes, Name of Parent/Guardian and the taking of photographs, movies or videotapes of my son/daughter and his/her school-related work by the Educational Talent Search Program of John Jay College of Criminal Justice. I also grant to the Educational Talent Search Program the right to edit, use and reuse said products for non-profit informational purposes, i.e. program newsletters, website, etc. I also hereby release the Educational Talent Search Program at John Jay College of Criminal Justice and its agents and employees from all claims, demands and liabilities whatsoever in connection with the above. Student s Signature: Parent s/guardian s Signature:

8 ACADEMIC RECORD RELEASE FORM Permission for Release of School Information High School/Education Institution: The student named below has applied and/or been selected to participate in the John Jay College/ Educational Talent Search Program. In order to assess this student's need for the program, potential for academic success, or academic progress, we are requesting a copy of his/her grades, transcript, test scores and/or any other relevant information. Student Information: Name: Date Of Birth: OSIS #: Social Security #: Home Address: Parent/Guardian Permission for release of school information: I, am the parent or legal guardian of the named above. I give my permission for the high school, educational institution or program to release grades, transcripts, test scores and/or any other relevant information to John Jay College/Educational Talent Search upon request of the program or its representative. I understand that the Educational Talent Search Program will keep this information confidential. Parent/Guardian Signature Student Signature Date Date Mail to: John Jay College of Criminal Justice Educational Talent Search Program 524 W. 59th Street ATTN: Josefina Couture Program Director

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