NAME (PLEASE PRINT)
LAST FIRST MI /

SOCIAL SECURITY NUMBER

/ Are you a 1st Generation College Student?
PERMANENT MAILING ADDRESS / CITY, STATE, ZIP CODE
COUNTY / PHONE / DATE OF BIRTH / SEX /

TRIBAL CITIZENSHIP NUMBER

Mo

/ Day / Yr / CO

ACT SCORE (Composite)

/ SAT SCORE TOTAL

(Verbal + Written)

/ Check One / HIGH SCHOOL NAME / HIGH SCHOOL CITY, STATE
q  Valedictorian
q  Salutatorian
High School County / HIGH SCHOOL DISTRICT
1 2 3 4 5 6 7 8 9 Contiguous
Awards Assembly Date (for check distribution) / Awards Assembly Location / Awards Assembly Time /
REQUIRED DOCUMENTS – ALL documents MUST come with application by April 5, 2014
DEADLINE: April 5, 2014
1.  Copy of Social Security Card
2.  Copy of blue Tribal Citizenship Card
3.  Official High School Transcript (7 Semester)
4.  2013– 2014 Application (This Form)
5.  Completed & Signed Substitute W-9 Form
6.  Letter from School Official /
RETURN COMPLETE PACKET TO:
Cherokee Nation Education Services
Valedictorian/Salutatorian Scholarship
Attention: Taryn Taylor
P.O. Box 948
Tahlequah, OK 74465
Phone: (918) 453-5000 Extension 5322
Phone: (800) 256-0671 Extension 5322

RELEASE OF INFORMATION AGREEMENT

The information contained in this application and possible award files at the Cherokee Nation College Resource Center, except my social security number, may be reviewed by my parents/guardian or released to persons authorized by the Principal Chief and Tribal Council members. Cherokee Nation may request copies of my grades, transcripts or financial records. Any modifications I wish to make to this Release of Information Agreement must be described in writing by a document bearing my signature and attached to this application.

STUDENT SIGNATURE: ______DATE: ______PRINTED NAME: ______

Dear School Administrator:

The Cherokee Nation recognizes and awards scholarship funds to Cherokee citizens who are named Valedictorian or Salutatorian of the 2014 class to students attending schools located within the Cherokee Nation scholarship service area and adjoining counties. The area is more clearly defined as:

1.  All high schools currently receiving Cherokee Tax Commission funding and those located in LeFlore, Haskell, Pittsburg, McIntosh, Muskogee, Wagoner, Tulsa and Osage counties in Oklahoma.

2.  All high schools located in Benton, Crawford, and Washington counties in Arkansas.

3.  All high schools located in Chautauqua, Cherokee, Labette and Montgomery counties in Kansas.

4.  McDonald County High School in Missouri.

The one-time scholarship award of $1,000.00 to a Valedictorian and $750.00 to a Salutatorian is in addition to any funds the recipients may receive through the Cherokee Nation College Resources. Students must have a GPA of at least 3.5 in order to qualify. In cases where schools do not name Valedictorians or Salutatorians, a Class Rank of 1 and 2 will qualify for the scholarship award.

The Cherokee Nation appreciates the opportunity to work with you to recognize the academic achievements of our citizens who are enrolled in your schools. Thank you for transmitting this information to the appropriate counselor or class sponsor.

Application forms, supporting documentation, and any request for information should be directed to Cherokee Nation Education Services, Attention: Taryn Taylor, P.O. Box 948, Tahlequah, OK 74465. Completed forms are due by April 5, 2014 to ensure that checks are ready for distribution in early May.