NAME:
Last
First
Middle

HOME ADDRESS:

Street

City	State	Zip

TELEPHONE:

NAME OF PARENTS/GUARDIANS:

NAME OF HIGH SCHOOL:
DATE OF GRADUATION (MM/YYYY):

NAME AND ADDRESS OF COLLEGE TO ATTEND:

DEGREE OR TRADE PURSUED:

DO YOU PLAN TO ATTEND FULL TIME OR PART TIME?

HAVE YOU APPLIED FOR ADMISSION?Yes  No
HAVE YOU BEEN ACCEPTED? Yes  No

DISCUSS IN A 500 WORD ESSAY THE FOLLOWING:

• YOUR INVOLVEMENT IN TRIBAL AND OR YOUR COMMUNITY ACTIVITIES.

• YOUR INVOLVEMENT IN SCHOOL ACTIVITIES

• YOUR EDUCATIONAL PLANS AND HOW THESE PLANS WILL COMPLIMENT YOUR FUTURE, TRIBE OR COMMUNITY.

LIST OTHER SCHOLARSHIPS/FINANCIAL AWARDS RECEIVED
(use additional page if needed).

ENCLOSE A REFERENCE LETTER FROM YOUR TEACHER OR COUNSELOR, CHURCH, EMPLOYER OR CIVIC ORGANIZATION.

PLEASE SUPPLY COPIES OF THE FOLLOWING: Tribal registration card, SAT scores, and copy of grade point average.