Program Application Talent Search 24.25

Thank you for your interest in our Amazing Educational Talent Search Program in the 2024-25 School Year! Please complete this application as thoroughly as possible. You cannot save and restart this application.

Our Program is available to students in these School Districts: Hanover Area, Hazleton Area, Scranton, Shenandoah Valley & Wilkes-Barre Area in grades 6th through 12th.

If you have any questions, please call our office at (570) 331-6755 or email Program Manager: Frannie@eocinc.org.

Student Section

Last Name *

First Name *

Address *

City *

Zip *

Ethnicity *

Date of Birth *

Cell Phone *

Gender *

Email (Not School) *

Are you Participating in another Other Federal Program

I have been in Foster Care or Guardianship

Do you feel that you are an English Language Learner?

Describe the reason that you want to join our Program: *

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Academic Information about Student

Current Grade Level *

Current School *

I would like the most help with:

Dual Enrollment *

Current Age: *

Dream College

Career Goal:

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Parent/Guardian Permission

Parent/Guardian Name *

Parent/Guardian Mobile Phone *

Contact 1 Email *

Parent/Guardian #1 Highest Education Completed *

Parent/Guardian #2 Highest Education Completed *

Marital Status *

Household Size *

Household Income Range *

Household Income is:

Is anyone in the Household Receiving any of these benefits:

I would like to register my other children in grades 6 through 12

I would like to become a member of the EOC Program that assists Adults

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Access to Quality Tutoring:

In order to maintain good grades or to improve your grades in specific subjects, the Educational Talent Search Program is committed to connecting you with quality tutoring opportunities. Should you wish to take advantage of these FREE tutoring opportunities-please contact your EOC Staff Member (570 331-6755 or visit our website: eocinc.org/tutoring/

My signature acknowledges that I have provided accurate information in this application and I am aware that I have access to quality tutoring.

Sign and Submit

Student Signature *

Please select a signature verification type.

Parent/Guardian Signature *

Please select a signature verification type.