Amarillo Chapter of Texas Alliance for Minorities in Engineering

An affiliate of TAME, Inc.

 STUDENT TRACKING FORM

The TAME Student Tracking Form below is required of all A C TAME participants.  The information on this form will assist TAME volunteers in tracking student academic progress.  The tracking form also provide a record of student participation in local TAME activities.  Funding for some TAME events depends on the accurate reporting of student information.  All specified information is required and must be filled in  for the student to be eligible to participate in TAME activities. Please review the release of information at the bottom of the form. If you, the parent/guardian agree please sign and return to the TAME event coordinator or turn in at event site.

             Name of Student____________________________________________ Date ________

             Address __________________________ City ______________ Zip Code ___________

             Phone (_____ ) __________________ __________ School ID ____________________

             School  ________________________________________________ Grade __________

             TAME Event ____________________________________________________________

 Number of years participating in TAME Events: ___________

            Ethnicity:          _____ African American       _____ Anglo American

                                    _____ Hispanic                   _____ Native American

                                    _____ Asian

                                    _____ Other (Please specify _________________________)

             Gender  Male: _____  Female: _____

             Name of Parent or Guardian ___________________________________________

             Relationship to student _______________________________________________

                                                    (Mother, Father, Grandfather, Guardian, etc.)

 I hereby grant permission for the information to be released to the TAME organization regarding my son - daughter shown above.  I understand that this information will be held in strict confidence and will be used only for scholarship information and/or program development as a tracking instrument.

 Signature of Parent or Guardian:_____________________________________________