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Canisius College
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Academic Talent Search Program Application
The Talent Search Program is designed to:
Identify qualified youth with potential for education at the post-secondary level and encourage them to complete secondary school and undertake a program of post-secondary education.
Publicize the availability of student financial assistance for persons who seek to pursue post-secondary education.
Encourage people who have not completed education programs at the secondary or postsecondary level, but have the ability to do so, to re-enter these programs.
Developed under the Higher Education Act of 1965, Talent Search provides academic, social, and career support services to encourage educational persistence and ultimately, postsecondary enrollment.
Please fill out all fields in each section to the best of your knowledge.
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Section I
First Name
Middle Name
Last Name
Phone Number
Email Address
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Birthdate
Birthdate
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Age
Are you a U.S. citizen?
Yes
No
If No, are you a permanent resident?
Yes
No
What is your citizenship ?
Afghanistan
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas Da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius, and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos Islands (Keeling Islands)
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Coral Sea Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Federated States of Micronesia
Fiji
Finland
Foreign/Unknown
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan De Nova Island
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia, Republic of North
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau, the Pacific Islands of
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
School
Grade
12
11
10
9
8
7
6
If selected "Other" for Grade please elaborate here:
Section II
Are you Hispanic?
Yes
No
Please select any that apply:
Please select any that apply:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
Not reported/NA
White
Gender:
Female
Male
Unknown
12th Graders Only-
Please list below your top three colleges you will be interested in attending:
College 1:
College 2:
College 3:
12th Graders Only-
Please list below your top career interest:
Interest 1:
Interest 2:
Interest 3:
Section III
Services Needed:
Services Needed:
Career Counseling
Reentering high school/ GED Programs
Personal and/or Academic Counseling
College Visitations and Fairs
Scholarship & Grants Information
Academic Advising and course selection assistance
College Admission and Forms completion
Financial Aid Counseling, and forms completion
Transition from Middle to High School Assistance
Reentering Postsecondary Education
SAT/ACT Preparation
Cultural Awareness Activities
Tutoring and/or Mentoring
Postsecondary Exploration
Section IV
Emergency Contacts
First
Last
Phone
Relationship
Father
Grandfather
Grandmother
Legal Guardian
Mother
Step-Father
Step-Mother
Unknown
First
Last
Phone
Relationship
Father
Grandfather
Grandmother
Legal Guardian
Mother
Step-Father
Step-Mother
Unknown
Section V
Adjusted Gross Income (AGI):
Adjusted Gross Income (AGI):
$0-18,210
$17,656-24,690
$23,896-31,170
$30,136-37,650
$36,376-42,615
$46,616-50,610
$46,856-57,090
$55,096-63,570
Number in Household:
1
2
3
4
5
6
7
8
9
10
11
12
12+
Mother's Name
Has completed 4-year college?
Yes
No
Father's Name
Has completed 4-year college?
Yes
No
Name of parent(s)/guardian whom the applicant lives with:
I (We) the Parent(s) /Guardian of aforementioned student above grant my son/daughter permission to participate in the Academic Talent Search Program. I authorize the Academic Talent Search Program of Canisius College to access my son/daughter’s report cards, transcripts, test scores, and other relevant information for my child to participate in the program. If applicable, I allow Academic Talent Search to have access to my child’s free or reduced lunch application information. I also allow Academic Talent Search to photograph my son/daughter during activities for use in newsletters, brochures, and/or press releases, and finally, to verify my son's/daughter's postsecondary enrollment at any institution. *Canisius Academic Talent Search Program does not share personal information. By typing name below and submitting you are agreeing with above mentioned statement.
Parent(s) or Guardian Signature
Today's Date
Today's Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Student Signature
Today's Date
Today's Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
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