Academic Talent Search - Sonoma State University

Sonoma State University
ACADEMIC TALENT SEARCH
1801 East Cotati Avenue, Rohnert Park, CA 94928  Office (707) 664-2359  Fax: (707) 664-3277
www.sonoma.edu/trio
8th-10th Grade Application
Directions: In order for your application to be considered, a completed and signed application with supporting forms must be
received in the ATS office by February 27, 2015. Please refer to the enclosed Application Check List for details.
PLEASE PRINT ALL INFORMATION IN INK.
Today’s DATE
Student Information:
Legal Name
(Last)
Telephone (
(First)
)
(Middle)
(Nickname, if any)
Email address:_______________________________________
Mailing Address
Street Address or PO Box
Sex:  Male
 Female
Are you a:  U.S. citizen
City
Zip
Date of Birth (month/day/year) ________________________________
 Permanent Resident
 Applying for Permanent Residency
Name of Current School
Grade Level
Which ATS Target School do you plan to enroll in next year? (Please check one)
Elsie Allen
El Molino
Healdsburg High Montgomery Piner
 Roseland University Prep  Santa Rosa High
 Sonoma Valley High
Rancho Cotate
 Windsor High
Other High School ________________________
Ethnicity:
1) Are you Hispanic/Latino?
 Yes
 No
2) Select one or more racial groups as they apply to you.
 American Indian or Alaska Native
 Hispanic/Latino
 Asian
 Black or African-American
 Native Hawaiian or other Pacific Islander
 White, European American, North African or Middle Eastern
 Yes/Si
Is English the primary language spoken at home?
 No/No
Inglés es el idioma predominante hablado en el hogar?
If no, what is the primary language used in the home? ______________________________________________
Please provide names of any siblings currently participating in ACADEMIC TALENT SEARCH
___________________________________________________
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ATS high school application 2015
Family Information
We are required by the U.S. Department of Education to obtain information from all students served by the Academic Talent
Search Program. The information is protected by the Privacy Act of 1974. No one may see the information unless employed by
Academic Talent Search or specifically authorized to see it. The U.S. Department of Education has the authority to gather such
information (20 USC 1231a). Your child is not eligible for any services unless the information is provided. El Departamento de
Educación Estadounidense nos requiere obtener información de todos estudiantes servidos por el programa de Academic Talent
Search. Esta información es protegida bajo el Acto de Privacidad de 1974 (Privacy Act of 1974). Nadie podrá ver su
información al menos de ser empleados por el programa de Academic Talent Search o si son específicamente autorizados. El
Departamento de Educación Estadounidense tiene la autoridad de colectar dicha información (20 USC 1231a). Su hijo/a no será
elegible para los servicios al menos de que proporcione tal información.
ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE
MOTHER/GUARDIAN NAME
OCCUPATION
Place of Employment
Work Phone or Cell Phone:
(please circle)
Birth or Adoptive mother: Does she have a degree from a four-year college? (B.A. or B.S.)  yes
Is birth or adoptive mother living at home? 
yes

no
FATHER/GUARDIAN NAME
OCCUPATION
Place of Employment
Work Phone or Cell Phone:
(please circle)
Birth or Adoptive father: Does he have a degree from a four-year college? (B.A. or B.S.)  yes
Is birth or adoptive father living at home? 
Does applicant live in a foster home?
 no

yes
yes


 no
no
no
Parent/Guardian Income Information
Please provide a signed copy (signed by at least one parent – the signature of your tax preparer is not sufficient) of
your completed Year 2013 or 2014 Federal Tax Form 1040 or 1040A pages 1 and 2. The student applicant’s
name and SSN must appear on the tax form.
IF you are unable to provide a copy of your completed Federal Tax Form for 2013 or 2014, you may provide a
signed Income Verification Form. Please contact 707-664-2359 to request one or download it from our website
http://www.sonoma.edu/trio/ats/ats_apply.htm
Your income information will be kept confidential and is used only to determine eligibility for Academic Talent
Search services.
Por favor presente una copia firmada (firma de por lo menos un padre - no es suficiente la firma de la persona quien
prepara sus impuestos) de las páginas 1 y 2 de su Formulario Federal de Impuestos 1040 o 1040A. El nombre del
estudiante solicitante y su número de seguro social debe aparecer en la hoja de impuestos.
Si NO puede presentar una copia del Formulario de Impuestos Federales del 2013 o el 2014, puede utilizar en su lugar el
formulario conocido como el Comprobante de Ingresos. Por favor contacte al 707-664-2359 para pedir un formulario o
puede bajar el documento a través de nuestra red: http://www.sonoma.edu/trio/ats/ats_apply.htm
Sus datos de ingresos se mantendrán en confianza total y solamente se usaran para determinar elegibilidad para servicios de
Academic Talent Search.
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ATS high school application 2015
Transcripts, Summary and Verification
1.
Transcript Waiver
I hereby authorize my student’s school(s) to provide Sonoma State University and its department, University Support &
Preparation Services, access to copies of my student’s academic records for the duration of the program and through
completion of post secondary education. I understand that these records will be kept in confidence and will be used to follow
my student’s educational progress or to determine when extra scholastic services are needed on his/her behalf.
2.
Summary
I understand that by signing this document, I am authorizing the above-mentioned student, if selected, to participate in
Academic Talent Search at Sonoma State University. I also authorize the employees of the program to have access to my
student’s academic records. I realize my son/daughter is making a commitment to participate in all Academic Talent
Search Program activities and to pursue the appropriate college preparatory classes necessary to enroll in a four-year
college or university. I understand that my student may not be considered for acceptance into the Academic Talent Search
Program if I fail to submit all required documents and signatures.
3.
Under penalties of perjury, I declare that I have examined this document, and to the best of my knowledge
and belief, they are true, correct, and complete. Bajo penas de perjurio, yo declaro que he examinado este documento, y
según mi leal entender y creencia, las declaraciones son verdad, corectas, y completas.
Parent/Guardian Signature
Date
I understand I am making a commitment to participate fully in all Academic Talent Search Program activities and to
pursue the appropriate college preparatory classes necessary for my enrollment in a four-year college or
university.
Student Signature
Date
PERSONAL ESSAY
Write a brief history of your achievements, activities, and career goals. Secondly, tell us how your
participation in the Academic Talent Search program will help you reach your goals. In 250-500
words, please write or type your essay on a separate sheet of paper and include with your
application. Remember to write your name on the essay!
INTERVIEW
Eligible 8th-10th grade applicants and their parent(s) or guardian(s) will be required to participate
in an interview with ATS advisors. The interview will provide you more information about the
program and our expectations, and will allow us to determine your commitment to participate in
Academic Talent Search. After your complete application is received, we will contact you to
schedule the interview with you and a parent.
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ATS high school application 2015
Student Needs Assessment
This survey contains a number of statements about student needs. We ask you to give your honest opinion about
how Academic Talent Search can meet your needs. All answers will be kept confidential.
no need
1
2
Applicant Name
Response Key
strong need
3
4
5
1.
I need to get better grades in school……………………………….………...1
2
3
4
5
2.
I need to learn how to take better notes....................................................... 1
2
3
4
5
3.
I need to learn test taking strategies and techniques……………...….…… 1
2
3
4
5
4.
I need to develop strong study habits……………………………............. 1
2
3
4
5
5.
I need to listen more effectively in class………………………...……..
1
2
3
4
5
6.
I need to learn how to ask questions in class…………………...………… 1
2
3
4
5
7.
I need to have better relationships with my teachers by learning
how to communicate more effectively……………………………….…… 1
2
3
4
5
8.
I need to better understand teachers, parents and other adults…….……… 1
2
3
4
5
9.
I need to learn how to get involved in clubs and organizations………………
1
2
3
4
5
10. I need to develop or improve my time management skills……………… 1
2
3
4
5
11. I need to know more about high school graduation requirements…..…… 1
2
3
4
5
12. I need information on college prep courses…………………………………1
2
3
4
5
and the college application process…………………………………..………
1
2
3
4
5
14. I need to learn more about ACT/SAT testing…………………………… 1
2
3
4
5
15. I need to learn more about financing a college education………………
1
2
3
4
5
16. I need to know how to prepare for a career(s) that interests me…............ 1
2
3
4
5
17. I need to experience more cultural activities………………………….…
1
2
3
4
5
18. I need to know how to set, assess, and evaluate my goals………………
1
2
3
4
5
19. I need to gain awareness of different cultures…………………….….…
1
2
3
4
5
2
3
4
5
13. I need to learn more about college admission requirements
20. I need to learn how to find what colleges are a good fit for me………..
1
Please list any other topics or issues you feel Academic Talent Search could help you with:
I would like information about: (circle all that apply)
Community Colleges
Universities
Vocational Schools
Military
I am interested in exploring the following careers:
________________________________________________________________________
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ATS high school application 2015