AUTHORIZATION TO REQUEST TRIBAL VERIFICATION
I, _______________________________________________________, authorize the Tohono O’odham
Education Assistance Program to contact the Tohono O’odham Nation Enrollment Program to verify my
tribal enrollment status. This authorization will serve to complete my application process for education
assistance and to authorize future verification requests throughout the duration of my participation in the
program.
L
AST NAME: _____________________________________
FIRST NAME: _____________________________________
MIDDLE NAME: _____________________________________
OTHER NAMES (if applicable): ______________________________________
D
ATE OF BIRTH: _____________________________________
TRIBAL ENROLLMENT NUMBER: ____________________________
I
understand any incomplete or missing information may delay or prevent the Tohono O’odham Nation
Enrollment Program from verifying my tribal enrollment status.
S
ignature: _____________________________________ Date: _________________________
Email this document to (
preferred
):
askeap@tonation-nsn.gov
OR
Mail this document to:
Education Assistance Program
P.O. Box 837
Sells, Arizona 85634
Typing in my name above serves as my signature.
