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. Copy of Tribal Enrollment 200-word essay on your educational goals Financial Needs Analysis (Bottom Half Completed by Financial Aid Office, submit to financial aid office at least 2-4 weeks prior to turning in application) Notarized Promissory Note Must have submitted a FAFSA for the current year (Some schools require completed verification paperwork, check with your financial aid office) Proof of applying to at least one other scholarship Signed FERPA waiver or release of financial information with your school Prior funded students are required to submit last quarter official transcripts. All the above must be completed and submitted to the Education Department *There is no longer a set deadline. Applications should be turned in at least 2-4 weeks prior to the start of your term. We need time for processing. The financial need analysis must be filled out by student and a financial aid officer to be considered complete and can take 4-6 weeks in some cases. . Reviewed by Higher Education Committee on: _____________ Approved ______ not approved ________ 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: _________________ Student ID #:_________________ 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 FINANCIAL NEEDS ANALYSIS Port Gamble S'Klallam Tribe 31912 Little Boston Rd NE Kingston, WA 98346 (360) 297-6322 or Email: Sasheen@pgst.nsn.us Student is responsible for submitting this form to the Financial Aid Office (F.A.O.) SECTION I (STUDENT COMPLETES) Students Name: __________________________ __ Student Id: _______________________________ Institutions Name: ___________________________________________ Family Size: ______________ Terms & Credits applying for: * Applicant must have submitted a current 20_____ Fall Quarter/Fall Semester years FAFSA application. (Check with F.A.O. 20_____ Winter Quarter/Spring Semester to see if any verification paperwork is needed) 20_____ Spring Quarter * Applicant must be enrolled and registered for 20_____ Summer Quarter classes when this form is filled out. ______ 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 _______________ Books & Supplies _______________ TOTAL EXPENSES _______________ TOTAL EXPENSES _______________ *PLEASE INDICATE QUARTER* _________________________________ ________________________________ 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______________ __________________________________________________________________________________________ This document must be notarized. NOTARY: