Pierce College Legacy Scholars Application 

Your child is interested in joining the Pierce College Legacy Scholars, a federally funded program that encourages students to graduate from high school and enroll in college. 

This free program support students through individual and group sessions throughout the year. The program provides workshops focused on success in high school, career awareness, college selection and financial assistance. In addition, we have special events including college visits and summer programming to give opportunities for students to gain leadership skills, learn more about careers and visit college campuses. 

Please fill out the application below. The information we collect is required from the Federal Government to ensure your child's eligibility. All information is kept confidential. 
Your Child's First Name
Preferred Name
Your Child's Last Name
Your Child's Middle Name
Your Child's School
Ethnicity *
What is your chillds gender? *
Student's Date of Birth *
Age *
What grade is your student in?
Parent/Guardian Name (First & Last)
Cell Phone
Email
Address
Address 2
City
State
Zip
Does your child live with you?
Other Parent/ Guardians Name (if not applicable, leave blank)
Parent/guardian 2: Cell Phone
Parent/Guardian 2: Email
Is your child a US citizen or permanent resident?
Parent Education Level *

Income Eligibility 

To be eligible for Legacy Scholars, a parents/guardians income after taxes must fall into one of the categories listed in the drop-down menu below. 

To estimate your income after taxes, please take your monthly take-home pay and multiple it by 12. 
Please indicate your family size/ income level: *
If your family receives additional support, please select all that apply: 
TANF/ SNAP benefits
Unemployment Benefits
Social Security Benefits
I agree to the Release of School Records above (please initial)
I agree to the Permission for Field Trip Participation statement above (please initial)
I agree to the Photo Authorization Statement above (Please initial)

Grievance Procedure

In line with Pierce College Talent Search Codes of Conduct, you have the right to be treated with respect at all times.  Pierce College Talent Search staff is to exhibit the highest standard of personal and professional behavior while performing their job duties. If you feel your rights have been violated you are dissatisfied or have complaints with the program the following steps are to be taken for resolution:

1. Talk to the person you have a concern about

2. If satisfaction is not achieved, talk with the Talent Search Directors

3. If satisfaction is not achieved, talk with the Talent Search Director's Supervisor.

I have read and understand the above grievance procedure to be followed if I feel that my rights have been violated. 
I agree to the Grievance Procedure Statement above (Please initial) *

My signature below indicates that to the best of my knowledge the information provided on this application is true, complete and accurate.

To sign this document, you must select one of the methods below to verify your signature. 
Please select a signature verification type.