Academic Talent Search Program Application

Mendocino-Cloverdale

Sonoma State University  <> 1801 E Cotati Ave <> Rohnert Park, CA 94928

Office (707) 664-2359 <>  Fax: (707) 664-3277 <>  Email: ats@sonoma.edu

precollegiate.sonoma.edu


  • Answer every question / Contesta todas las preguntas
  • Signatures are REQUIRED / Se REQUIREN firmas
  • Include a copy of current school transcript / Incluya una copia de tu reporte de calificaciones más reciente
  • Report your accurate family size and income / Reporta el tamaño de tu familia precisa e ingresos

   Taxable Income / Ingreso Imponible (1040 line 10, 11b, or 15)

   Wages, salaries, tips, etc./ Sueldos, salario, propinas, etc.

   Adjusted Gross Income / Ingreso Bruto Ajustado


SECTION A - Student Information:
First Name *
Middle Name
Last Name *
Nickname (if any)
Date of Birth *
Gender *
Address *
Apt/Unit
City *
State *
Zip *
Phone *
Email

SECTION B - School Information:
Current Grade Level *
Current School *
Which ATS Target School do you expect to enroll in when you attend high school? *
Target School (If not listed above)

SECTION C - Student Background:
NOTE: Permanent residents and those applying for residency must provide official documentation. You will be contacted by ATS staff for verification.
Citizenship/Residency Status *
What is the primary language spoken at home? *
Ethnicity *

SECTION D - Student Academic Questions:

We require the student to answer thoughtfully and type responses to each of the questions below. Answers may also be submitted via email to ats@sonoma.edu. Please include the student's name, school, and grade level on email submissions.

What is your favorite subject in school? Why is it your favorite?
What is difficult for you in school? How do you handle this challenge?
Why do you want to earn a college degree?

SECTION E - Transcripts:

Upload a copy of your current school transcript. You may also email the file to ats@sonoma.edu or mail it to:

Academic Talent Search

1801 E Cotati Ave

Rohnert Park, CA 94928

Student Agreement and Signature:

I understand that I am making a commitment to fully participate in all Academic Talent Search Program activities and to pursue the appropriate college preparatory classes necessary for my enrollment in a college or university. I verify that the responses to the student questions on this application are my own.

Student Signature
Please select a signature verification type.

SECTION F - Parent Education:

Mother / Guardian / Madre / Parent 1
Name / Nombre *
Occupation / Ocupación
Phone / Teléfono *
Does this parent live at home? / Este padre vive en casa?
Highest level of education completed / Más alto nivel de educación terminado *
College / Universidad
Father / Guardian / Padre / Parent 2
Name / Nombre
Occupation / Ocupación
Phone / Teléfono
Does this parent live at home? / Este padre vive en casa?
Highest level of education completed / Más alto nivel de educación terminado
College / Universidad

SECTION G - Family Income Information:

Directions: You are required to document your family’s income for the purpose of determining your child’s eligibility for the program. All information will be held in strict confidence.

Please note that we are requesting TAXABLE INCOME, not family’s total income. This can be found on federal tax forms IRS 1040, line 10, 11b, or 15.

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Instrucciones: Se le requiere que documente los ingresos de su familia con el propósito de determinar la elegibilidad de su hijo/a para el programa. Toda la información se mantendrá en estricta confidencialidad.

Tenga en cuenta que estamos solicitando INGRESO TRIBUTABLE, no el ingreso total de la familia. Esto se puede encontrar en los formularios de impuestos federales IRS 1040, línea 10.

 

Taxable Income / Ingreso Tributable
Family size including parents, children, and other dependent family members / Incuyendo padres, hijos y otros familiares dependientes

Parent Agreement and Signature

Transcript Waiver

I hereby authorize my student’s school(s) to provide Sonoma State University and its department, Pre-Collegiate Programs, access to copies of my student’s academic records for the duration of their participation in the ATS program and through completion of postsecondary 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.

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Por la presente autorizo a la escuela (s) de mi estudiante de proporcionar Sonoma State University y su departamento, Pre-Collegiate Programs, el acceso a copias de los expedientes académicos de mi hijo durante la duración de su participación en el programa de ATS y hasta la finalización de la educación terciaria. Entiendo que estos registros se mantendrán confidenciales y serán utilizados para seguir el progreso educativo de mi hijo o para determinar cuándo se necesitan servicios escolares adicionales en su nombre.

Program Agreement

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 student 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 will not be considered for acceptance into the Academic Talent Search Program if I fail to submit all required documents and signatures.

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Entiendo que al firmar este documento, yo autorizo que el estudiante antes mencionado, si es seleccionado, para participar en Academic Talent Search en Sonoma State University. También autorizo a los empleados del programa para tener acceso a los expedientes académicos de mi hijo. Me doy cuenta de que mi hijo / hija está haciendo un compromiso de participar en todas las actividades del programa Academic Talent Search y de seguir las clases adecuadas de preparación universitaria necesarias para inscribirse en un colegio o universidad de cuatro años. Entiendo que mi estudiante NO será considerado para ser aceptado al programa Academic Talent Search si fallo a presentar todos los documentos y firmas requeridas.

Verification

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.  

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Bajo penas de perjurio, yo declaro que he examinado este documento, y según mi leal entender y creencia, las declaraciones son verdad, correctas, y completas.

Signature

Parent/Guardian Signature
Please select a signature verification type.