2022 Daytona State College TRiO Talent Search

Participant Application

The Daytona State College (DSC) TRiO Talent Search program identifies and assists Flagler County students at select schools who have the interest and potential to succeed in higher education. The program provides academic, career, and financial counseling to its participants and encourages them to graduate from high school and enroll in the post-secondary institution of their choice.

Students must be in grades 6 - 12 and attend one of our target schools:

  • Flagler Palm Coast High School
  • Buddy Taylor Middle School
  • Bunnell Elementary School
  • Rymfire Elementary School
  • Wadsworth Elementary School

For more information please visit our website: https://www.DaytonaState.edu/trio-talent-search 

In order to participate, a completed application must be submitted, and parents must complete the financial income section as required by the guidelines set forth by the U.S. Department of Education. If you have any questions, please contact our office at (386)506-3866. Your child must meet with a TRiO Coordinator at least once per month during the school year to stay active and receive program benefits (i.e. tutoring, fee waivers, college tours).
Please upload a copy of the student's most recent report card/progress report below:
Report Card Upload

Part I: Student Information
Current School: *
Student's Current Grade Level: *
Student's current GPA:
Student's gender *
Student's First Name: *
Student's Middle Name:
Student's Last Name: *
Student's Street Address (include apartment or lot number if applicable): *
Student's City: *
Student's State: *
Student's Zip Code: *
Student's Cell Phone:
Student's Date of Birth: *
Student's Current Age: *
Is the student currently enrolled in Dual Enrollment classes? *
If dual-enrolled at DSC, what is the student's DSC ID?
Student's school ID:
Student's Email:
Student's Ethnicity: *
Note: Participants must be a US citizen or legal resident of the United States in order to participate in and receive services from the DSC TRiO Talent Search Program.
Is the student a US Citizen? *

Student Needs/Interest Assessment
Check box or enter (type) all that apply.
Does the student plan to attend college?
Please select high school programs the student is enrolled in:
Advanced Placement (AP)
International Baccalaureate (IB)
Cambridge AICE
Please select any courses the student has completed or is currently enrolled in:
Algebra I
Algebra II
Geometry
Physics
Biology
Chemistry
Please list any foreign language courses the student has completed:
Please list any other higher level mathematics courses the student has completed:
Please list any other higher level science courses the student has completed:
Is the student currently in the Take Stock in Children program (TSIC)?
Which of the following does the student plan to enroll in after completing high school?
Part II: Family/Parent Information

The following information is to be completed by the student's legal parent or guardian.

The personal information, including financial status and educational levels provided below, is used for reporting purposes with the Department of Education. The information is required to determine eligibility established by regulation of the Department of Education and will remain confidential and is protected under the Family Educational Rights and Privacy Act (FERPA, 20 USC 1231a). All information is required for the student to be considered for this program.
How many people live in the student's household (including the student)? *

Household Taxable Income

Please note that Taxable Income is usually LOWER than the Adjusted Gross Income. Taxable Income can be found on line 15 of the IRS 1040 tax form for 2020. If you have any questions, please call (386) 506-3866. 

There are two options for verifying taxable income and an additional option if no taxes were filed last year.

You only need to complete one of the following three options:

Option 1: Self-report household income information by selecting the correct option in the drop-down below.

Option 2: Attach last year’s tax form in the indicated space below.

Option 3 - If the student's household did not submit a tax form last year, enter self-report income information in the indicated box.

Option 1: Self-report household taxable income level of the household where the student spends 50% or more of their time:
Option 2 : Upload parent's/guardian's most recent tax form:

Option 3: If you did NOT file a tax form, complete the following:
Wages, Salaries, or Tips:
OtherNon-taxable Income: $ (Disability, AFDC, Veteran Benefits, Retirement, Unemployment)
Does the student or the student's family receive assistance from any of the following?
Not Applicable
Social Security Insurance
Veteran's Benefits
Food Stamps/SNAP/WIC
Public Assistance (Wellfare/A.F.D.C./TANF)
Free or Reduced Lunch Program
Please read the following statement, then sign and date. By signing this Income Verification Form, I am verifying that the information that I have provided to the DSC TRiO Talent Search program is true and correct. This information is protected by the Privacy Act. No one may see the information unless they work with or for the DSC TRiO Talent Search Program, or are specifically authorized to see it.
Parent/Guardian Signature: *
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.
Part II: Family/Parent Informtion Continued
With whom does the student live? *

Parent/Guardian 1 Information

For Parent/Guardian 1 information, please enter the information of the primary parental contact for the student.
Parent/Guardian 1 Name: *
Has the student's Parent/Guardian 1 completed a 4-year degree? (This means a bachelor's degree or higher level.) *
Parent/Guardian 1 Marital Status: *
Parent/Guardian 1 Email: *
Parent/Guardian 1 Street Address (include apartment or lot number if applicable): *
Parent/Guardian 1 City: *
Parent/Guardian 1 State: *
Parent/Guardian 1 Zip Code: *
Parent/Guardian 1 Cell Phone: *
Parent/Guardian 1 Preferred Contact Method: *
Parent/Guardian 2 Information
Parent/Guardian 2 Name: *
Has the student's Parent/Guardian 2 completed a 4-year degree? (This means a bachelor's degree or higher level.) *
Parent/Guardian 2 Marital status: *
Parent/Guardian 2 Email: *
Parent/Guardian 2 Street Address (include apartment or lot number if applicable): *
Parent/Guardian 2 City: *
Parent/Guardian 2 State: *
Parent/Guardian 2 Zip Code: *
Contact 2 Cell Phone: *
Contact 2 Preferred Contact: Method: *

For my child to remain eligible to participate in the DSC TRiO Talent Search program, I will:

• Ensure my child meets with a DSC TRiO Talent Search Coordinator at least once per month

• Notify DSC TRiO Talent Search staff if my child receives disciplinary action at school

• Attend parental workshops provided by DSC TRiO Talent Search

• Notify the DSC TRiO Talent Search office about any changes in contact information

• Encourage my child to seek academic assistance when needed (ask about tutoring options)

• Encourage my child to participate in the DSC TRiO Talent Search program workshops, activities, and campus visits.

I certify that the information provided is true and accurate to the best of my knowledge. I understand that my child is required to meet with a Talent Search Coordinator at least once per month and participate in Talent Search activities whenever possible. I understand that my involvement and support is critical to my child’s success and I fully support my child’s participation in the DSC TRiO Talent Search program.
Parent/Guardian Signature: *
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.
PERMISSION TO ACCESS STUDENT ACADEMIC RECORDS
As the legal parent/guardian of the student named below, who currently attends Flagler County Schools, I hereby give permission for the staff of the Daytona State College TRiO Talent Search program to have access to my child's academic records.
Student Name: *

Progress Monitoring

I hereby give permission for the DSC TRiO Talent Search program to retrieve, store and report education verification information and student outcomes research that is gained from the National Clearinghouse and other services.

By signing this document, I give permission to Flagler County Schools to release my child’s academic records to a DSC TRiO Talent Search staff member.
Parent/Guardian Signature: *
Signature Type: Simple    Start Over
Click here to start signing.