Fillable Application to be enrolled with Central Council of (Central Council Tlingit and Haida Indian Tribes of Alaska)

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Application to be enrolled with Central Council of (Central Council Tlingit and Haida Indian Tribes of Alaska)

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U.S.A. forms for Central Council Tlingit and Haida Indian Tribes of Alaska

BROWSE CENTRAL COUNCIL TLINGIT AND HAIDA INDIAN TRIBES OF ALASKA (AK) FORMS

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Application to be enrolled with
Central Council of Tlingit & Haida
Indian Tribes of Alaska
Attn: Program Compliance
320 W. Willoughby Ave., Suite 300, Juneau, AK 99801
ATTENTION: MEMBERSHIP IS LIMITED TO TLINGITS AND HAIDAS.
Front and Back Must Be Complete
Full Name:
Other Names Used (Maiden, Etc.):
Mailing Address:
Residential Address:
Phone No: ( ) Email Address:
Birthdate: Indicate: Natural Adopted
Soc. Sec. No.: Moiety: Eagle Raven Clan:
Application Filed By: Self *Parent *Sponsor *(complete below)
Name of Person Filing Application:
Mailing Address:
Relationship to Applicant:
Voting Community
Please complete only if you live 100 miles outside of one of the communities listed below. Check one only.
One or more of the following documents is required for verification. Incomplete application will be returned.
A Certified Birth Certificate (Listing one or both parents.) Photo copies not accepted.
Paternity Papers (Required Native parent is not on birth certificate)
Notice of False or Misleading Information: If any statements are proven to be misleading or false, penalties may
include: delay, disenrollment, criminal or civil charges filed against applicant or sponsor.
Privacy Act Notification: All enrollment information will remain confidential.
I hereby certify that the statements given above for the purpose of Tlingit and Haida enrollment are correct and
true.
Signature Date
Juneau
Klukwan
Metlakatla
Angoon
Kake
Pelican
Wrangell
Craig
Kasaan
Petersburg
Yakutat
Haines
Ketchikan
Saxman
Seattle
Hoonah
Klawock
Sitka
San Francisco
Hydaburg
Anchorage
y:\2013\tribal enrollment\tribal enrollment application revised feb 2013 4.doc
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CENTRAL COUNCIL
Tlingit and Haida Indian Tribes of Alaska
Father:
Program Compliance • Family Tree
Legend
DOB - Date of Birth Father:
Enroll # - Enrollment Number
Natural DOB Enroll # Mother:
Other Relatives:
Father :
Father:
DOB Enroll #
Fathers Siblings:
Mother:
DOB Enroll # Mother:
Applicant:
Father:
Siblings:
Father:
Natural DOB Enroll # Mother:
Mother:
Father:
DOB Enroll #
Mothers Siblings:
Mother:
DOB Enroll # Mother:
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Application to be enrolled with Central Council of (Central Council Tlingit and Haida Indian Tribes of Alaska)

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Completed 18 November 2021

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