Central College TRIO ETS

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Please fill out this quick survey to see if your child may qualify for the ETS program.

Student Name: *

Student address (Street address, city, and zip code) *

Student cell phone number: *

Student email address: *

What school does student currently attend? *

East HS

Harding MS

Hiatt MS

Hoyt MS

Lincoln HS

McCombs MS

North HS

Oskaloosa MS

Oskaloosa HS

Saydel HS

Weeks MS

Woodside MS

Other:

What grade is student in? *

Other:

Is this student interested in going to college? *

Yes

If the student is interested in going to college, which workshops and activities would be most helpful? Check all that apply. *

Academic Planning

ACT Preparation

Career Planning

College Information/Planning

Healthy Lifestyle Habits

Money Management

Required

Do the student’s parent(s) have a 4-year college degree? Only report the parent(s) the student lives with more than 50% of the time. *

Yes

How many people are in the parent(s) family? (Include all individuals in the family who are provided for, completely or more than 50%, by the family taxable income. This includes college students age 21 or younger who may be living elsewhere while in school. Also include parents in this count.) *

Does student's parent/guardian receive SNAP benefits? *

Yes

If you do not receive SNAP benefits, please check the box that matched the parents' TAXABLE income. Please note: This is the amount after all taxes AND deductions are taken out of the income. It is on line #10 of this year's taxes.

Under $19,140

$19,141 - $25,860

$25,861 - $32,580

$32,581 - $39,300

$39,301 - $46,020

$46,021 - $52,740

$52,741 - $59,460

$59,461 - $66,180

over $66,181

Clear selection

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