TRiO Talent Search
Department of Student Services
Kankakee Community College
100 College Drive, Kankakee, IL 60901
It is very important that this application be completed accurately and neatly. All information is strictly confidential
and will be maintained in the TRiO Talent Search Office. PLEASE RESPOND TO EVERY ITEM. PLEASE PRINT. USE
BLUE OR BLACK INK.
STUDENT INFORMATION
Today’s date:
Student’s Full Name
Date of Birth:
 Male  Female
Social Security # (required)
 I am currently enrolled in school. Grade
Name of School:  Kankakee Junior High School
 St. Anne High School
Address:
State:
Zip:
Email address:
 Kankakee High School
 Other:
City:
Home Phone #:
Facebook user name:
Cell Phone #:
Twitter user name:
Please indicate ethnic- racial background: (check all that apply)
 African-American  Hispanic American  Caucasian  Native American  Asian American
 Other:
Are you a US citizen:  Yes  No
Do you prefer to communicate in:
 English  Spanish  Other:
Parent/Guardian with whom student lives (Mother/other)
Name:
Email Address:
Cell Phone #:
Work Phone #:
This parent has a 4-year Baccalaureate college degree:
Yes No
Parent/Guardian with whom student lives (Father/other)
Name:
Email Address:
Cell Phone #:
Work Phone #:
This parent has a 4-year Baccalaureate college degree:
Yes No
FAMILY INFORMATION (To be completed by PARENT) signature required on back
Number of people living in your home, including yourself:
List all people who live with you:
Name
Age
SELF
Relationship to You
Current School or Employment
INTEREST/CAREER INFORMATION please check all that apply
 Agriculture
 Education
 Math
 Social Science/Culture
 Computer
 Architecture
 Engineering
 Medicine
 Arts/Humanities
 Language
 English/Literature
 Music
 Athletics
 Environment
 Politics
 Natural Science
 Business
 History
 Nursing
 Other:
Grade Level