Iowa Tribe of Oklahoma HIGHER EDUCATION SCHOLARSHIP APPLICATION Check List

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1 Iowa Tribe of Oklahoma HIGHER EDUCATION SCHOLARSHIP APPLICATION Check List Documents Needed To Complete Application Completed Application Financial Need Analysis (completed) Iowa Tribe CDIB Letter of Admission from a College or University High School Diploma or GED (College transcript if you are a continuing student) Academic Goals (Write a short paragraph explaining) Eligibility New Students Member of the Iowa Tribe of Oklahoma High School or GED Graduate Applying to an Accredited college or University Formally Accepted By a College or University Assurance that Applicant will be Successful in Completing Degree Eligibility Continuing Students Maintain a Minimum of 12 Credit Hours Registered each Semester. Submit Grade report at the End of Semester Maintain Cumulative GPA of at least 2.0 on a 4.0 scale Submit Enrollment Schedule for each Semester Iowa Tribe of Oklahoma Higher Education Scholarship Revised 3/5/12 Page 1

Member of the Iowa Tribe of Oklahoma High School or GED Graduate Applying to an Accredited college or University Formally Accepted By a College or University Assurance that Applicant will be

2 Iowa Tribe of Oklahoma ~Higher Education~ R.R. 1, Box 721 Perkins, Oklahoma Chris Hill, Education Specialist Ph. (405) Ext. 209 Fax (405) All information requested is voluntary, but necessary to determine eligibility. Failure to fully complete all applicable parts may result in delay of processing or in denial of services due to incomplete information needed to make a determination of eligibility. Please complete the following in ink. Thank you. FALL DEADLINE: JULY 15 TH SPRING DEADLINE: DECEMBER 15 TH NAME: (Please Print) Address: / / / / Last First Middle Birth Date Social Security # Street City State Zip Phone # Message # Address GED or High School Diploma (Please Circle One) 19 or 20 Single Married Year Graduated or GED Marital Status (please circle one) # Dependents APPLICATION REQUEST: FALL: (Year) Spring: (Year) Accredited College/University Address City State Zip College Major Anticipated Graduation Degree Iowa Tribe of Oklahoma Higher Education Scholarship Revised 3/5/12 Page 2

Failure to fully complete all applicable parts may result in delay of processing or in denial of services due to incomplete information needed to make a determination of eligibility.

3 Year in College: (Please Circle One) Freshman Sophomore Junior Senior I Will Live: (please circle one) On Campus Off Campus With Parents Do you have any physical limitations that would interfere with your education? YES or NO If Yes, Explain. STATEMENT OF EDUCATION PURPOSE: I affirm that I will use any funds received from the Iowa Tribe s Higher Education Grant Program solely for the expenses connected with attendance at the Education Institution mentioned above. I acknowledge that any information submitted is confidential, and that all information I have submitted is true and correct to the best of my knowledge. I consent to the release of information to necessary agencies in order to complete my financial aid packet. I agree to provide a copy of my GRADES, FINAL TRANSCRIPT and/or GRADUATION NOTICE to the Iowa Tribe s Education office at the end of each academic term for grant compliance. I further assure that I will notify the Education Office Before withdrawing from classes or school. SIGNATURE: DATE: Iowa Tribe of Oklahoma Higher Education Scholarship Revised 3/5/12 Page 3

STATEMENT OF EDUCATION PURPOSE: I affirm that I will use any funds received from the Iowa Tribe s Higher Education Grant Program solely for the expenses connected with attendance at the Education

4 FINANCIAL NEED ANALYSIS FORM Iowa Tribe of Oklahoma Higher Education R.R. 1, Box 721 Perkins, Oklahoma Phone (405) Fax (405) Part 1 To be completed by Student NAME: SOCIAL SECURITY # FULL ADDRESS: PHONE: MESSAGE: MARITAL STATUS: Single Married # of Dependent Children APPLICATION REQUEST: Fall Spring (Please Put Academic Year) PLEASE CIRCLE: College or 4 year University Semester Basis Trimester Quarter Basis CHECK ONE: FR SOPH JR SR #HRS (12 or more or Full Time per institution) I hereby authorize my college/university to release the following information to the Iowa Tribe for grant eligibility determination. Signature/Date Part II To be completed by Financial Aid Officer (Please Use Fall & Spring Totals. SCHOOL/STUDENT AMOUNT STUDENT AMOUNT AWARDS AMOUNT EXPENSES RESOURCES TUITION Student/Spouse PELL GRANT CONTRIBUTION FEES Parent FEDERAL SEOG CONTRIBUTION BOOKS VETERAN S BENEFITS FEDERAL WORK STUDY SUPPLIES SOCIAL SECURITY FEDERAL PERKINS ROOM & BOARD VOCATIONAL FEDERAL STAFFORD REHABILITATION DEPENDENCY FELLOWSHIPS FEDERAL SLS Iowa Tribe of Oklahoma Higher Education Scholarship Revised 3/5/12 Page 4

R. 1, Box 721 Perkins, Oklahoma 74059 Phone (405) 547-2402 Fax (405) 547-1090 Part 1 To be completed by Student NAME: SOCIAL SECURITY # FULL ADDRESS: PHONE: MESSAGE: E-Mail: MARITAL STATUS: Single

5 TRANSPORTATION IHS GRANTS COLLEGE/UNIVERSITY SCHOLARSHIP PERSONAL STATE INDIAN FEDERAL PLUS LOAN EXPENSES SCHOLARSHIPS LOAN FEES STATE TUITION GRANT OTHER (LIST) OTHER (LIST) COLLEGE/UNIVERSITY SCHOLARSHIP INCENTIVE TUITION WAIVER OTHER (LIST) TOTAL SCHOOL/ $ TOTAL $ TOTAL AWARDS $ Student Expenses RESOURCES This Student Aid Package is consistent with packages prepared for students who are not eligible for BIA Education Grants. FINANCIAL AID OFFICER: COLLEGE/UNIVERSITY ADDRESS: Print Name: Signature: Date: Phone: Fax: NOTE: A FAX is acceptable for deadlines; however the original must be mailed to this office. Thank you. Iowa Tribe of Oklahoma Higher Education Scholarship Revised 3/5/12 Page 5

with packages prepared for students who are not eligible for BIA Education Grants.

EDUCATION DEPARTMENT (406) 768-5136 (406) 768-3556 Fax

EDUCATION DEPARTMENT (406) 768-5136 (406) 768-3556 Fax Dear Applicant, Thank you for your interest in applying for the Fort Peck Assiniboine and Sioux Tribes Higher Education Scholarship. Please be sure