Port Gamble S'klallam Tribe

TRIBAL EDUCATION SCHOLARSHIP

Undergraduate New Applicant

Name of Applicant: ______Date: ______

If you are applying for Tribal Scholarship for Academic school year ______, you are required to complete a Tribal Scholarship application. Incomplete applications will not be reviewed. Students must apply for funds each Quarter/Semester.

Note: Private and Vocational Institutions will be considered for funding on an individual basis, depending on available funds.

£  Copy of Tribal Enrollment

£  200-word essay on your educational goals

£  Financial Needs Analysis (Bottom Half Completed by Financial Aid Office)

£  Notarized Promissory Note

£  Notarized Release of Academic Information

£  Prior funded students are required to submit last quarter official transcripts

All of the above must be completed and submitted to the Education Department no later than 4:30 pm on the date of deadline.

Port Gamble S’Klallam Higher Education/Vocational Training Policy and Procedures are available on request.

*Deadlines for complete application are Fall- August 31, 2016, Winter- December 14, 2016, and Spring- March 24, 2017

** Maximum award per quarter is $3,300.00 for tuition, books, and supplies. Funding will be awarded depending on availability.

Reviewed by Higher Education Committee on: ______Approved ______not approved ______

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Port Gamble S'Klallam Tribe

Tribal Education Scholarship

The maximum award for tribal scholarships is based upon the average in state amount and funds available per term per student.

Today’s date: ______Year Attending: ______

If employed by the Port Gamble S'Klallam Tribe- Tribal Department: ______

Are these courses job related? (Core classes included) YES / NO

Are there any funds in department budget? YES/ NO

STUDENT INFORMATION

Legal Name: ______

FIRST MIDDLE LAST (MAIDEN)

Enrollment Number: ______Male ____ Female ____

Former Name(s): If your first or last name has changed, indicate your former full name(s):
______

(______) ______-______(______) ______-______

CELL/HOME TELEPHONE NUMBER MESSAGE PHONE NUMBER EMAIL ADDRESS

______-______-______

MAILING ADDRESS SOCIAL SECURITY NUMBER

______/______/______

CITY STATE ZIP DATE OF BIRTH

How long is your mailing address valid? ____ Indefinitely or until: ____ / ____ / ____

______

MOTHER’S NAME FATHER’S NAME

______

MOTHER’S TRIBE FATHER’S TRIBE

State of legal residency? ______

Marital Status: Single ____ Married ____ Divorced ____ Separated ____

COLLEGE/VOCATIONAL SCHOOL ATTENDING

Name of College: ______City: ______State: ______

College Phone and Fax Number: (______) ______-______(______) ______-______

PHONE FAX

Degree: ______Current Credits Total: ______

Which term does your institution follow? Semester ______Quarter ______

Attending: (please indicate year in space provided)

Fall Quarter/Fall Semester: ______Winter Quarter/ Spring Semester: ______

Spring Quarter: ______Summer Quarter: ______

Financial Aid Form Completed on _____ / _____ / ______

Full-time (12+ credits) _____ Part-time (1-11 credits) ______

WORKING: Full-time ______Part-time ______Unemployed ______

Residing in: Dormitory ______Apartment ______Parents ______Own Home ______

CERTIFICATION

I, ______hereby certify that all the information provided on the application is correct to the best of my knowledge.

______

APPLICANTS SIGNATURE DATE

RELEASE OF ACADEMIC INFORMATION

I, ______consent to the release of my transcript and any other

APPLICANTS NAME

relevant academic information to the Port Gamble S'Klallam Career and Education Department, College Financial Aid Office and the Port Gamble S'Klallam Tribal Higher Education Committee as applicable to determine my Tribal Scholarship Eligibility.

This Authorization is in effect for the ______School Year.

SCHOOL TERM

______-______-______(______)______-______

PRINT APPLICANTS NAME SOCIAL SECURITY NUMBER PHONE NUMBER

______

MAILING ADDRESS APARTMENT NUMBER

______

CITY STATE ZIP CODE

______

APPLICANTS SIGNATURE DATE OF APPLICATION

Any questions please contact: Phone Number: (360) 297-6322 or Fax Number: (360) 297-6206

This document must be notarized.

NOTARY:

FINANCIAL NEEDS ANALYSIS

Port Gamble S'Klallam Tribe

31912 Little Boston Rd NE Kingston, WA 98346

(360) 297-6322 or Fax (360) 297-6206

Student is responsible for submitting this form to the Financial Aid Office

SECTION I (STUDENT COMPLETES)

Students Name: ______Social Security Number: ______-______-______

Institutions Name: ______Family Size: ______

Terms & Credits applying for: Financial Needs Analysis Deadlines

20_____ Fall Quarter/Fall Semester Fall Quarter/Fall Semester ……August 21st

20_____ Winter Quarter/Spring Semester Winter Quarter/Spring Semester ...November 27th

20_____ Spring Quarter Spring Quarter………………………. March 4th

20_____ Summer Quarter Summer Quarter ………………………TBD

______Full-Time 12+ Credits ______Part-Time 1-11 Credits

I hereby authorize the above named college(s) financial aid office to release the Academic Information and Financial Aid information below to the Port Gamble S'Klallam Tribal Education Department.

______

PRINT NAME SIGNATURE DATE

**Section II MUST be completed by the Financial Aid Office and returned to the address above**

SECTION II (FINANCIAL AID OFFICER COMPLETES)

SCHOOL EXPENSE

FOR QUARTER: FOR SEMESTER:

Tuition & Fees ______Tuition & Fees ______

Books & Supplies ____$300.00____ Books & Supplies ____$450.00___

(Max per Quarter, Do not Change) (Max per Semester, Do not Change)

TOTAL EXPENSES ______TOTAL EXPENSES ______

*PLEASE INDICATE QUARTER*

GRANTS AND/OR SCHOLARSHIPS / FALL QUARTER/
FALL SEMESTER / WINTER QUARTER/
SPRING SEMESTER / SPRING QUARTER / SUMMER QUARTER
Pell Grant
TOTAL

______

SIGNATURE OF FINANCIAL AID OFFICER DATE

______(______) ______-______(______) ______-______

PRINT NAME TELEPHONE NUMBER FAX NUMBER

EDUCATION FUNDING REQUEST

PROMISSORY AGREEMENT

Name: ______Date: ______

I understand that I am required to reimburse the Port Gamble S'Klallam Tribe if:

§  I receive financial support for college from other funding source(s) in excess of tuition, course books and materials.

§  I drop out of one or more of the courses that I have received funding for.

§  I drop out of the college that I have received funding for.

I, ______agree to repay all funds provided to me by the tribe to

(Name)

attend college if I do not fulfill the requirements of this agreement. I understand that by not reimbursing the tribe I may not be eligible for future assistance from the Tribe. I understand that the funding for college will be considered a balance due.

Applicant signature: ______Date______

*Note: Funding does not include costs for food, clothes, shelter or transportation.

This document must be notarized.

NOTARY:

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