Daytona State College TRiO Talent Search 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 a Flagler County middle or high 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 1: Student Information
Student Current School: *
Student Current Grade Level: *
Student Current GPA: *
Student Gender *
Student First Name: *
Student Middle Name:
Student Last Name: *
Student Street Address (include apartment/unit/lot number if applicable): *
Student City: *
Student State: *
Student Zip Code: *
Student Flagler School Email: *
Student personal email *
Student's Cell Phone:
Student 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 School ID: *
Student 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 for all that apply.
Advanced Placement (AP)
Advanced International Certificate of Education (AICE)
Take Stock in Children program (TSIC)
International Baccalaureate (IB)
Does the student plan to attend college? *
Which of the following does the student plan to enroll in after completing high school?
Part 2: 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

Taxable Income is usually LOWER than the Adjusted Gross Income and is typically on line 15 of the IRS 1040 tax form. 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 menu below.

Option 2: Attach a copy of 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:
Monthly 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? Check all that apply.
Social Security Insurance
Veteran's Benefits
Food Stamps/SNAP/WIC
Public Assistance (Wellfare/A.F.D.C./TANF)
Free or Reduced Lunch Program
None of the above

Please read the following statement before signing:
My signature below verifies that the financial information 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.

  • Manually sign the signature pad, OR
  • Type your full name in the signature box below the pad
  • Check the box to agree
  • Click the "Sign and Submit Signature" button
Parent/Guardian Signature: *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Who does the student live with? *

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: *
What level of college experience do you have? *
Parent/Guardian 1 Marital Status: *
Parent/Guardian 1 Email: *
Parent/Guardian 1 Street Address (include apartment/unit/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

For Parent/Guardian 2 information, if a secondary parent or guardian DOES NOT live full-time with the student, then enter "N/A" in all the required fields in this section.
Parent/Guardian 2 Name: *
What level of college experience do you have? *
Parent/Guardian 2 Marital Status: *
Parent/Guardian 2 Email: *
Parent/Guardian 2 Street Address (include apartment/unit/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.
Part 3: Parent/Guardian Consent
PERMISSION TO ACCESS STUDENT ACADEMIC RECORDS

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 entering my initials below, I give permission to Flagler County Schools to release my child’s academic records to a DSC TRiO Talent Search staff member.
Parent/Guardian Initials *
LIABILITY RELEASE
As the legal parent/guardian of the student named in this application, I hereby join in the release of Daytona State College, its trustees, officers, employees and agents from any and all liability or claims for losses or damages that the student may sustain while participating in travel activities sponsored by the DSC TRiO Talent Search program. My initials below indicate that I expressly understand and agree that Daytona State College, its trustees, officers, employees and agents assume no liability for my child's participation in travel activities.
Parent/Guardian Initials *
RELEASE/CONSENT TO USE PHOTOGRAPHS

Photographs of our participants may be included on our website or other college-approved media. We require your authorization to use any photos we take of your child in order to do this.

Please read the following statement before giving your answer:

I hereby irrevocably consent to and authorize the use and reproduction by Daytona State College, or any person or organization authorized by Daytona State College of any and all photographs or videos which have been taken of my child, both singularly and as a part of a group, without any compensation to me. All positives and negatives shall constitute solely the property of Daytona State College.
Do you agree to allow us to photograph your child? *
Part 4: Student Essay (Required)
Please upload or use the space below to complete a short essay explaining why you (student) need the services provided by the Daytona State College TRiO Talent Search program:
Student Essay: *
Student Essay Upload:
STUDENT PARTICIPATION AGREEMENT

This section is to be completed by the student. Please read the following statement before signing:

By signing below, I hereby agree to participate fully in all scheduled activities. I will attend all required meetings and workshops. I will commit myself to the DSC TRiO Talent Search program until I graduate from high school. I am aware that I must meet with my TRiO Coordinator at least once per month during the school year, or I will be placed inactive and will not have access to any of the services or benefits of the program.

  • Manually sign the signature pad, OR
  • Type your full name in the signature box below the pad
  • Check the box to agree
  • Click the "Sign and Submit Signature" button
Student Signature: *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
FINAL CERTIFYING STATEMENT

As the legal parent/guardian of the student named in the application, my signature below indicates that the information given on this application is true and accurate to the best of my knowledge. I also certify that the deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. Additionally, I understand that the information given herein is for the receipt of services funded by a federal grant. The information provided may be disclosed to third parties for the purpose of verifying eligibility requirements, and in an effort to prevent fraud, waste and abuse in providing federal assistance.

  • Manually sign the signature pad, OR
  • Type your full name in the signature box below the pad
  • Check the box to agree
  • Click the "Sign and Submit Signature" button
Parent/Guardian Signature: *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.

Thank you for your interest in the Daytona State College TRiO Talent Search Program. If you have any further questions, please feel free to contact our office at (386) 506-3866. If your child is accepted, you may expect an email notification within 7 to 10 business days.  

YOU MUST CLICK THE "SUBMIT APPLICATION" BUTTON BELOW TO FINISH THE APPLICATION PROCESS.