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.

Section I

First Name

Hayden brook

Middle Name

Lynn

Last Name

Hodges

Phone Number

+1 716-599-6510

Email Address

haydenhodges112@gmail.con

Mailing Address
Country

United States

Street

102 fernhill avenue

City

Buffalo

State

New York

Postal Code

14209

Birthdate

January 19 2009

Age

14

Are you a U.S. citizen?

Yes

School

Buffalo Academy Vis/Perform Arts

Grade

Section II

Are you Hispanic?

No

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

Section III

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

Kimberly

Last

Coston

Phone

716-597-5940

Relationship

Grandmother

First

Timothy

Last

Kye

Phone

7166021148

Relationship

Grandfather

Section V

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:

Mother's Name

Alysha Hodges

Has completed 4-year college?

No

Father's Name

Isaac parker

Has completed 4-year college?

No

Name of parent(s)/guardian whom the applicant

lives with:

Kimberly coston

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

Kimberly coston

Today's Date

August

22

2023

Student Signature

Hayden hodges

Today's Date

August

22

2023

Submit

INFORMATION

BOOKSTORE

ANDREW L. BOUWHUIS, SJ LIBRARY

EMPLOYMENT

QUICK LINKS

DIRECTORY

ACADEMIC CALENDAR

MYCANISIUS

CONTACT US

2001 MAIN ST
 BUFFALO, NY14208-1517
UNITED STATES

 (716) 883-7000

 (716) 888-2525

 INFO@CANISIUS.EDU

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