APPLICANT INFORMATION
* 1. First Name
2. Middle Initial
* 3. Last Name
* 4. Date of Birth
5. Gender
M F
* 6. Mailing Address
* 7. City
* 8. State
* 9. Zip Code
10. Home Telephone
11. Parent Cell or Work Telephone
12. Student Email Address
13. Parent Email Address
* 14. Current Grade
5 6 7 8 9 10 11 12
15. Do you have a sibling in METS?
yes no
* 16. School
New Sweden Consol Woodland Consol Caribou Community School Caribou High - Searsport Middle Searsport High Central Elementary Central Middle Central High Etna-Dixmont School Nokomis Middle School Nokomis High School Somerset Valley Middle School Sebasticook Valley Middle School - Lewiston MS Lewiston HS Lewiston HS - Next Step Montello Elementary School Farwell Elementary School Thomas J. McMahon Elementary School Robert V. Connors Elementary School Geiger Elementary School - Crooked Elementary Lake Region Middle Lake Region High Sebago Elementary School Stevens Brook Elementary School - Oxford Elementary School Oxford Hills Middle Oxford Hills High Guy E. Rowe Elementary School Paris Elementary School Hebron Station School Agnes Gray School Otisfield Community School Harrison Elementary School - Cony Middle and High School Cony Middle School Cony High School Farrington Elementary School Sylvio Gilbert Elementary School Lillian P. Hussey Elementary School Lincoln Elementary School - Other
* 17. Do you identify yourself as Hispanic or Latino?
yes no
18. If no, check all that apply:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
* 19. Please select your citizenship status:
U.S. Citizen
Permanent Resident of the U.S.
In the United States for other than a temporary purpose, and provides evidence from INS of intent to become a permanent resident
Permanent Resident of Guam, the Northern Mariana Islands, or the Trust Territory of the Pacific Islands (Palau)
Resident of the Federated States of Micronesia or the Republic of the Marshall Islands
None of the above
HOUSEHOLD INFORMATION
20. With whom do you live?
Two Parents
Single Parent
Grandparent(s)
Legal Guardian
Self
21. Household #1
22. Household #2 (if more than one):
EDUCATIONAL GOALS
23. What are your plans after high school (check all that apply):
Two Year College
Four Year College
Technical School
Military
Other (please specify):
24. What knowledge and skills would you like to work on with your METS advisor (check all that apply)?
Study Skills
Career Awareness
Paying for College
College Choice
Tutoring
College Application
Test Taking Skills
Course Selection
Goal Setting
Mentoring
METS is required to verify that our participants meet federal criteria based on educational background and
household income level. This information is required of all applicants. METS and the University of Maine ensure
that all information provided will be held in confidence. Please complete all items.
Please indicate the highest education level completed by each of your natural or adoptive parents. Please do not
indicate educational levels for stepparents, grandparents or legal guardians.
* 25. Parent One - Highest Education Level:
Did not complete High School High school diploma or GED/HiSET Some college (did not complete a degree) 2-year college (completed an Associate Degree, Diploma or Certificate) 4-year college (completed a Bachelor Degree or higher)
26. Parent Two - Highest Education Level:
Did not complete High School High school diploma or GED/HiSET Some college (did not complete a degree) 2-year college (completed an Associate Degree, Diploma or Certificate) 4-year college (completed a Bachelor Degree or higher)
27. Number of family members in your home (including yourself)
28. Is your family currently receiving SNAP benefits?
yes no
29. Is your family current receiving TANF?
yes no
It is a federal requirement of the METS program to verify the family's taxable income. Please select your taxable income range below. Please do not use total income. Taxable income is the amount of income subject to federal and state tax, after deductions and exemptions. Please reference line 15 on your most recent Federal 1040 Form. Some examples of income to NOT include: Child Support, Non-taxed Social Security Benefits, State and Federal Assistance, and/or other Non-Taxed income. All information on this application is held in the strictest confidence.
* 30. Taxable Income Range:
I do not file $0 - $23,940 $23,941 - $32,460 $32,461 - $40,980 $40,981 - $49,500 $49,501 - $58,020 $58,021 - $66,540 $66,541 - $75,060 $75,061 - $83,580 More than $83,581
31. Referred to METS By:
32. Do you have any questions that you'd like us to answer?
SIGNATURE
I/We certify that the information provided on the application is true and correct to the best of my/our knowledge.
I/We authorize the use of my image in METS publications and media releases to the METS program. I/We authorize the
release of school records and free lunch records to the METS program. All information provided on this application will
be held in confidence by the METS program. I/We understand that if I need accommodations for a disability to participate in
METS, or any of its scheduled activities, I must contact the Director of Maine Educational Talent Search at 207.581.3736 at
least 30 working days prior to the activity. I/We understand that providing false or inaccurate statements on this application
may result in removal from METS.
Student Signature
Use your mouse (or your finger or stylus, if on a mobile device) to sign this application in the space below. If you need to erase the signature and start over, click the Erase Student Signature button.
Parent or Guardian Signature
Use your mouse (or your finger or stylus, if on a mobile device) to sign this application in the space below. If you need to erase the signature and start over, click the Erase Parent/Guardian Signature button.
Click the button below to submit this application.