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CHEYENNE AND ARAPAHO TRIBES HIGHER EDUCATION SCHOLARSHIP
TYPE: Undergraduate and Graduate
PURPOSE: The United States Government, through the Bureau of Indian Affairs, provides annual educational assistance to eligible Indian students to enable them to attend institutions of higher learning. The Cheyenne and Arapaho Tribes, pursuant to P.L. 93-638, have contracted to administer this program for enrolled tribal members.
ELIGIBILITY: To qualify for a scholarship, the applicant must be an enrolled tribal member with the Cheyenne and Arapaho Tribes; a high school graduate or GED graduate; approved for admission by the college/university; in need of financial aid; and give reasonable assurance they will be successful in completing a 2-year or 4-year degree program.
AMOUNT: Based on the students financial need and availability of scholarship funds.
APPLICATION DEADLINE: Fall Semester – June 1; Spring Semester – November 1; Summer Semester – April 1. Students are required to complete one application per academic year. The additional required documents do not have to be submitted by the deadline (ex., class schedule, Financial Needs Analysis, degree plan, personal letter, and official transcripts). Late applications may be accepted, but must be accompanied with an appeal letter.
ADDRESS INQUIRES TO: Cheyenne and Arapaho Tribes Higher Education Scholarship Program P.O. Box 167 Concho, OK 73022 Direct: (405) 422-7646 (405) 422-7439 (405) 422-7653 Fax: (405) 422-8211 Email: [email protected]
DEPARTMENT OF EDUCATION Higher Education Scholarship Program PO Box 167 Concho, OK 73022
405-422-7646405-422-7439405-422-7653
Fax: 405-422-8211 [email protected]
SCHOLARSHIP APPLICATION REQUIRED DOCUMENTS The following documents are required to complete your Higher Education Scholarship application. Your application will not be complete until all documents have been received in the Higher Education office.
1. HIGHER EDUCATION SCHOLARSHIP APPLICATION PAGE
2. STATEMENT OF PRIVACY – Must be signed and dated by applicant
3. APPLY FOR FAFSA – Each student is required to complete the Free Application for Federal Student Aid(FAFSA) in order to receive any scholarship funds. Please visit https://fafsa.ed.gov to complete the onlineapplication.
4. PERSONAL LETTER – Informal letter that states information about yourself, the college/university you willattend, your major and the degree you will receive, why you are in need of a scholarship, and your plans aftergraduation.
5. HIGH SCHOOL TRANSCRIPT or GED TEST SCORES & DIPLOMA/CERTIFICATE
6. COPY OF COLLEGE ADMISSION LETTER/LETTER OF ACCEPTANCE
7. DEGREE PLAN/SHEET– List of classes you must complete in order to receive your degree. This can be found on thecollege/universities website or obtained from your advisor.
8. CLASS SCHEDULE – The students name, number of credit hours enrolled in, and classes must be listed on the schedule.
9. FINANCIAL NEEDS ANALYSIS FORM (FNA) – Part 1 to be completed by the student. Part 2 to be completed and signedoff by the college/universities Financial Aid Office and returned to the Cheyenne and Arapaho Higher Education Office.
10. OFFICIAL COLLEGE TRANSCRIPT - From previous college/universities attended. Unofficial transcripts will NOT beaccepted. (Does not apply to first time Freshman)
11. APPEAL LETTER FOR LATE APPLICANTS – All late applications must be accompanied with an appealletter or applications will not be considered for scholarship funding.
12. LETTER FROM ADVISOR – If a student is required to attend summer classes, a letter from the students’academic advisor stating summer classes are required in order to stay on track for the students anticipatedgraduation date.
13. GRADUATION VERIFICATION – Senior level applicants are required to send a letter from their academicadvisor listing their anticipated date of graduation.
14. GRADUATE STUDENTS are required to apply for a second scholarship from a second source/organization andsend an award letter or denial letter.
DOCUMENTS LISTED BELOW ARE ONLY REQUIRED IF THEY APPLY TO YOU
DEPARTMENT OF EDUCATION Higher Education Scholarship Program PO Box 167 Concho, OK 73022
405-422-7646405-422-7439405-422-7653
Fax: 405-422-8211 [email protected]
HIGHER EDUCATION SCHOLARSHIP APPLICATION
Academic Year: 20___ - 20___
Name S.S.# Last First MI Maiden
Tribal Roll # Date of Birth
Mailing Address Street City State Zip
Email Address Phone #
Which semester(s) will you be attending? Entire Academic Year Fall Only Spring Only Summer
Enrollment Status: Full Time Part Time Gender: Male Female
Name of High School Graduation/GED Date
College Major Expected Graduation Year
Degree Expected to Obtain: Associate’s Bachelor’s Master’s Doctorate
Current Classification: Freshman Sophomore Junior Senior Graduate Doctorate
I will live: On Campus Off Campus
Have you previously received a Cheyenne and Arapaho Tribes Higher Education Scholarship? YES NO
If yes, what was the last semester and year you received a scholarship?
I have fully read and accept the conditions as stated in the BIA-HIE Student Guidelines.
STATEMENT OF EDUCATION PURPOSE: I declare I will use any funds I receive under the Bureau of Indian Affairs Cheyenne and Arapaho Tribes Higher Education Scholarship Program solely for expenses related with the attendance at:
Name of College/University
Address of College/University
Signature of Student Date
DEPARTMENT OF EDUCATION Higher Education Scholarship Program PO Box 167 Concho, OK 73022
405-422-7646405-422-7439405-422-7653
Fax: 405-422-8211 [email protected]
STATEMENT OF PRIVACY
The Privacy Act of 1974 requires each Federal Agency that maintains a system of information on individuals to inform those individuals to:
A. The authority (whether granted by statute, or by executive order of the President) which authorizes the solicitation ofthe information and whether disclosures of such information is mandatory or voluntary;
B. The principal purpose or purposes for which the information is intended to be used:C. The routine uses which may be made of the information, as published pursuant to paragraph (4)(D) of this
subsection; andD. The effects on him/her, if any, of not providing all or any part of the requested information
The Cheyenne and Arapaho Tribes Higher Education Scholarship Program operates under the general authority of 25USC 13. 42 Stat. 208 P.L. 67-85 with specific regulations contained in 25 CFR, Subchapter E, Part 32, Administration ofEducation Loans, Grants and other Assistance with Higher Education. In accordance with the accountability required for theadministration of funds appropriated for the program and in order to provide services to recipients, and to declare eligibility,certain information is required of all applicants. This form solicits the required information. Use of personal data will beavailable to authorized sources upon request.
The applicant should understand that the intent of collecting and maintaining this data on individuals is for determining eligibility of the applicant and to provide the means for producing certain statistical records required of this office, specifically, the release and submission of semester grades and official transcripts to the Cheyenne and Arapaho Tribes Higher Education Scholarship Program.
I give authority to release to appropriate persons, in the event of an emergency, information in regard to my application.
I have read and acknowledged the statement of privacy. I hereby provide the required information and authorize the use of such information to the uses of specified in the statement. I, also, understand that I must provide my official transcript for the previous funded semester for compliance before the next semesters scholarship award is processed.
NAME: Printed or Typed
Signature
Date
405-422-7646405-422-7439405-422-7653
Fax: 405-422-8211 [email protected]
DEPARTMENT OF EDUCATION Higher Education Scholarship Program PO Box 167 Concho, OK 73022
FINANCIAL NEEDS ANALYSIS FORM (FNA) Academic Year: 20 - 20
PART 1 – TO BE COMPLETED BY THE STUDENT
Name S.S.# D.O.BAddress Phone # Marital Status: Single Married Divorced Dependents: Tribal Roll # Type of School: Community College College/University Private Tribal Classification: Freshman Sophomore Junior Senior Graduate Student ID: Check one: Male Female Check one: New Student Continuing Transfer Major Number of Credit Hours Enrolled Applied for: Pell Grant Tuition Waiver Student Loan Work Study Other
PART 2 – TO BE COMPLETED BY YOUR SCHOOLS FINANCIAL AID OFFICE
PLEASE REFRAIN FROM THE USE OF WHITEOUT
APPROVED STUDENT BUDGET FOR ACADEMIC YEAR 20____-20____ $__________________
SCHOOL EXPENSES: STUDENT RESOURCES: AWARDS:
Tuition $___________________ Family Contribution $___________________ Pell $__________________ Fees $___________________ Student Contribution $___________________ Tuition Waiver $__________________ Books $___________________ Veterans’ Benefits $___________________ Work Study $__________________ Supplies $___________________ Social Security $___________________ State Tuition Grant $__________________ Room & Boards $___________________ Vocational Rehab $___________________ SEOG $__________________ Transportation $___________________ AFDC $___________________ Unsub Student Loan* $__________________ Personal Expenses $___________________ Fellowships $___________________ Sub Student Loan* $__________________ Other (List) $___________________ IHS Grant $___________________ GSL* $__________________
$___________________ State Ind. Scholarship $___________________ NDSL* $__________________ $___________________ Other (List) $___________________ Parent PLUS* $__________________ $___________________ $___________________ Other (List) $__________________ $___________________ $___________________ $__________________ $___________________ $___________________ $__________________
*only include if student has ACCEPTED loan
TOTAL STUDENT EXPENSES: $___________________ TOTAL RESOURCES: $___________________ TOTAL AWARD: $___________________
PLEASE CHECK: FOR SEMESTER Total Student Expense – Total Resources = Total Financial Need $___________________ FOR QUARTER Total Financial Need – Total Awards + Unmet Need $___________________ FOR YEAR
FINANCIAL AID OFFICER: COLLEGE/UNIVERSITY: This address will be used to mail tribal scholarship checks
Name College/University Name
Email Address Mailing Address
Date Phone Number
Signature Fax Number
Please return completed form to: Cheyenne and Arapaho Tribes *I give permission to my College/University’s Financial Aid Office to release my financial Higher Education Scholarship Program aid information to the Cheyenne and Arapaho Tribes Higher Education Scholarship Program
P.O. Box 167 Concho, OK 73022
[email protected] FAX: (405) 422-8211 Student Signature
DEPARTMENT OF EDUCATION Higher Education Scholarship Program PO Box 167 Concho, OK 73022
405-422-7646405-422-7439405-422-7653
Fax: 405-422-8211 [email protected]
*This form is to be completed by your schools Financial Aid office & returned to our office. Scholarship funds will not be disbursed until this form is completed and returned to our office.
Consent to Release or Obtain Student Information This consent must be completed and returned to the Higher Education Office IF a student would like their information to be released to a specific individual, such as a parent/guardian, spouse, etc. This form is not a requirement if a student does not have anyone to list.
I, , grant the following individual listed (Student Name)
below, permission to receive and obtain information regarding my application status, check disbursement status,
and/or other information regarding my Higher Education Scholarship application. I understand that I am
required to inform the Higher Education Scholarship Program if this person is no longer authorized to receive
and obtain my information.
I authorize release of my information to:
(Information Recipient Name)
Relation to Student: ___________________________________________
Student/Applicant’s Signature Date
OFFICE USE ONLY
Date Received: Date Confirmed:
HIE Staff Signature:
405-422-7646405-422-7439405-422-7653
Fax: 405-422-8211 [email protected]
DEPARTMENT OF EDUCATION Higher Education Scholarship Program PO Box 167 Concho, OK 73022
Submit Completed Application to: Mailing Address: Higher Education Program, PO Box 167, Concho, OK 73022
Email Address: [email protected] Fax Number: 405-422-8211
Cheyenne and Arapaho Higher Education Program Gaming Application Date of Application
Academic Year 20____ - 20____
Which type of assistance/awards are you applying for? (Please read and check one of the following)
1. GAM-HIE Scholarship - This includes those students not eligible under the BIA-HIE Contract guidelines with demonstrated need, full time and part time student expenses such as tuition, fees and books and any emergency supplemental needs.
2. College GPA Incentive Awards - based on semester GPA for full time students. Please provide official transcripts.
3. High School Senior Expenses - $100 per student for senior related expenses.
4. Graduation from High School and College Incentives. Please provide official transcripts.
5. College Prep Expenses - ACT and SAT Fees, College Campus Tours, College Concurrent Enrollment & College Admission fees.
6. Special Circumstances and Special Requests for Assistance – including assistance for Students who have been selected to participate in an academic program or camp.
MALE FEMALE
TO BE COMPLETED BY STUDENT or PARENT/GUARDIAN OF STUDENT
STUDENT’S NAME
DATE OF BIRTH AGE GRADE
MAILING ADDRESS
CITY STATE ZIP
PHONE NUMBER
EMAIL ADDRESS
TRIBAL ROLL#
COMPLETE THE INFORMATION BELOW IF APPLICANT IS A HIGH SCHOOL STUDENT
PARENT/GUARDIAN’S NAME
PARENT/GUARDIAN’S PHONE NUMBER
STATEMENT OF PRIVACY The Cheyenne and Arapaho Tribes has a contract with the Bureau of Indian Affairs Higher Education Assistance Program which operates under the general authority of 24 USC Chapter 13, 42 Stat. 208 P.L. 67-85 with specific legislation contained in 25 USC, Subchapter E, Part E. Administration of Educational Loans, Grants, and Other Assistance for Higher Education. In accordance with the accountability required for the Administration of the funds appropriated for the program and in order to provide services to recipients, and to declare eligibility, certain information is needed of applicants. This form solicits the required information. Use of personal data will be available to authorized sources upon request. The applicant should understand that the intent of collecting and maintaining this data on individuals is for determining eligibility of the applicant and to provide the means for producing certain statistical records required of this office. Failure on the part of the applicant to provide the requested information will preclude the applicant from eligibility in obtaining higher education assistance under this program. I have read the statement of privacy listed with this application form. I hereby provide the required information and authorize the use of such information to the extent of the uses specified in the statement.
Student Signature Date
Parent Signature (if applicable) Date
Please call our office for any questions: 405-422-7646
Submit Completed Application to: Mailing Address: Higher Education Program, PO Box 167, Concho, OK 73022
Email Address: [email protected] Fax Number: 405-422-8211
Cheyenne and Arapaho Higher Education Program Gaming Application Date of Application
Academic Year 20____ - 20____
Which type of assistance/awards are you applying for? (Please read and check one of the following) 1. GAM-HIE Scholarship - This includes those students not eligible under the BIA-HIE Contract guidelines with demonstrated need, full time and part time student expenses such as tuition, fees and books and any emergency supplemental needs. 2. College GPA Incentive Awards - based on semester GPA for full time students. Please provide official transcripts. 3. High School Senior Expenses - $100 per student for senior related expenses. 4. Graduation from High School and College Incentives. Please provide official transcripts. 5. College Prep Expenses - ACT and SAT Fees, College Campus Tours, College Concurrent Enrollment & College Admission fees.
6. Special Circumstances and Special Requests for Assistance – including assistance for Students who have been selected to participate in an academic program or camp.
TO BE COMPLETED BY STUDENT or PARENT/GUARDIAN OF STUDENT STUDENT’S NAME DATE OF BIRTH AGE GRADE MALE FEMALE MAILING ADDRESS CITY STATE ZIP PHONE NUMBER EMAIL ADDRESS TRIBAL ROLL# *PLEASE PROVIDE A COPY OF YOUR CDIB. COMPLETE THE INFORMATION BELOW IF APPLICANT IS A HIGH SCHOOL STUDENT PARENT/GUARDIAN’S NAME PARENT/GUARDIAN’S PHONE NUMBER
STATEMENT OF PRIVACY The Cheyenne and Arapaho Tribes has a contract with the Bureau of Indian Affairs Higher Education Assistance Program which operates under the general authority of 24 USC Chapter 13, 42 Stat. 208 P.L. 67-85 with specific legislation contained in 25 USC, Subchapter E, Part E. Administration of Educational Loans, Grants, and Other Assistance for Higher Education. In accordance with the accountability required for the Administration of the funds appropriated for the program and in order to provide services to recipients, and to declare eligibility, certain information is needed of applicants. This form solicits the required information. Use of personal data will be available to authorized sources upon request. The applicant should understand that the intent of collecting and maintaining this data on individuals is for determining eligibility of the applicant and to provide the means for producing certain statistical records required of this office. Failure on the part of the applicant to provide the requested information will preclude the applicant from eligibility in obtaining higher education assistance under this program. I have read the statement of privacy listed with this application form. I hereby provide the required information and authorize the use of such information to the extent of the uses specified in the statement. Student Signature Date
Parent Signature (if applicable) Date
Please call our office for any questions: 405-422-7646
