Thank you for your interest in Alcorn State University Talent Search 61 North Program!  Please complete this application thoroughly. For your convenience, note that the application cannot be saved and restarted. We recommend reviewing all required items before submitting. The application will automatically close after 20 minutes of inactivity.

If you have any questions, please call our office at (601) 877-3023. We are happy to help!
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Section 1: Student Information
Last Name *
First Name *
Middle Name *
Date of Birth *
Current Age *
Race/Ethnicity *
Are you a legal U.S. citizen?
Gender *
Street Address *
City *
State *
Zip *
Cell Phone *
Personal Email Address *
We use email and text to send out important ETS Information. May we contact you? *
Do you have access to a home computer with internet? *
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Section 2: Academic Information
Current School *
Grade *
What is your cumulative Grade Point Average (GPA) *
Are you currently enrolled in dual enrollment courses? *
If you are enrolled in dual enrollment, which courses are you taking?
Are you a participant in another TRIO program? (Educational Talent Search, Upward Bound, Upward Bound Math Science) *
If so, which TRIO program are you a participant in? *
Which of the following areas do you need assistance in? *
What careers are you interested in exploring? *
Do you have the ability and desire to continue education beyond high school (community college/ university)? *
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Section 3: Parent/ Guardian Information
Parent/Guardian #1 Full Name? *
Relationship to Student *
Parent/Guardian Cell Number *
Parent/Guardian #1 Email Address *
Parent #1 Education Level *
Parent/Guardian #2: Full Name
Relationship to Student
Parent/Guardian #2 Cell Number
Parent/Guardian #2 Email Address
Parent #2 Education Level
We use email and text to send out important ETS Information. May we contact you? *
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Section 4: Household Income
How many people live in your household including students away at college. *
Household Income Range *
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Section 5: Educational Record Release

The Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, is a federal law that protects the privacy of student education records. The Educational Records Release is required for participation in the Educational Talent Search Program. By completing this authorization, I give permission for the Educational Talent Search (ETS) Program at Alcorn State University to have access to all middle school/high school, student educational related records of:
Student's Full Name *
Student's Date of Birth *

I understand, the student’s Educational Records Release must be signed in order for the student to receive services from the Educational Talent Search Program (ETS).

Student educational record information may be used to:

  • determine eligibility to receive services from the ETS Program,
  • monitor status and progress in secondary school
  • guide student regarding academic advising,
  • communicate with school personnel regarding the needs of the student.
  • Track post-secondary education attendance and completion.

I give the Educational Talent Search Program, permission to have access to my child’s middle school/high school information in the school data system. Necessary records may include, but are not limited to information in the secondary educational records such as grade reports/transcripts, test scores, attendance, behavior reports, medical, court documentation and other records. It is my understanding that these records will be released only to those who have legitimate educational interest, or otherwise are required by law to be disclosed by ASU.

I understand the Educational Records Release can be revoked at any time by submitting a written request to the Educational Talent Search Program at Alcorn State University. 

Parent/Guardian Signature (Student may sign if 18 years of age)
Signature *
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Signature: (Type in your full name)
I agree to the terms included.
Today's Date: *
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SIGN and SUBMIT

IMPORTANT NOTE: Applications cannot be submitted without signature verification.

 
I give my permission for my child to participate in the Educational Talent Search (ETS) Program through Alcorn State University. I verify all of the information on this application is true and to the best of my knowledge, correct. *
Signature Type: Simple    Start Over
Click here to start signing.
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Signature: (Type in your full name)
I agree to the terms included.
Date Signed *