University of Louisiana at Monroe
TRiO Programs-Educational Talent Search
ELIGIBILITY FORM
STUDENT INFORMATION
Please Print
Student Name:
School:
Grade:
SSN:
Date of birth:
Age:
Gender:  Male  Female
Do you participate in the free or reduced
lunch program?
Are you a U.S. Citizen?
If no, are you a Permanent Resident?
 Yes
 Yes
Free Reduced
 Pay full price
 No
 No
Alien Registration Number:
Are you Hispanic?
 Yes
 No
What is your ethnic/racial background?
 Asian
 American Indian/Alaska Native
 Hispanic/Latino
 Native Hawaiian/Pacific Islander
 Two or more races
Black/African American
White
Name of parent/guardian:
If NOT your parent, indicate relationship
to you (aunt; grandmother, etc.):
How many family members live
How many parents
in your home, including yourself?
are in the home?
Did your mother graduate from a 4 year college?
 Yes
 No
If yes, name of college:
Mother’s occupation:
Did your father graduate from a 4 year college?
 Yes
 No
If yes, name of college:
Father’s occupation:
NEEDS ASSESSMENT
Check the following services you think would be helpful to you.
 Selecting a career
 Tutoring
 Developing study skills
 Selecting high school courses
 Preparing for the ACT
 Gaining admission to college
 Obtaining money for college
 Selecting a college major
 Personal Counseling
Signature:
TRiO Programs-Educational Talent Search-ULM
OFFICIAL USE ONLY
This is to certify the student’s participation in the National School Lunch program
(free/reduced lunch), as well as the parental education level. The student is identified
as being in need of, and has the ability to benefit from, TRiO Programs-Educational
Talent Search services and should be selected for participation in the program.
A.I. (reduced only):
Family size (reduced only):
School official signature:
This is to certify the student does not participate in the National School Lunch Program
(free/reduced lunch); however, confirms the parental education level. The student is
identified as being in need of, and has the ability to benefit from, TRiO ProgramsEducational Talent Search services, and should be selected for participation in the
program.
School official signature:
TRiO PROGRAMS-EDUCATIONAL TALENT SEARCH USE ONLY
U.S.D.E. acceptable A.I. for a family of this size (reduced only):
Eligibility:
 FG
 LI
 N
ETS Staff Signature:
Date:
Executive Director Approval:
TRiO Programs-Educational Talent Search-ULM