___________________ _________________________________________________________
LASTNAME FIRSTNAME MIDDLENAME MAIDENNAME
DATEOFBIRTH____________ ___ MALE FEMALE __________________________
MO.DAYYEARSOCIALSECURITYNUMBER
______________________________________________________________________________
PHYSICALADDRESS(Required)CITY STATE ZIP
_______________________________________________________________________________
MAILINGADDRESSCITY STATE ZIP
___________________________
PRIMARYPHONENUMBER
HaveyouregisteredasacitizenoftheCherokeeNationbefore? YES NO
When?______________________________Registrationnumber? _____________________________
Theperson whosigns theapplication isrequired toencloseacopy ofhis/herStateID orState
Driver’sLicense.
Parentsmustsignforapplicant(s)under18.
Otherpersonmaysignforminorordisablediflegal
documentationissubmitted.
___________________________________________________________________________________
SIGNATUREOFAPPLICANT(Requiredinink) DATEOFSIGNATURE
BY SIGNING THIS APPLICATION FOR CITIZENSHIP, I VERIFY ALL INFORMATION PROVIDED IS TRUE AND CORRECT. UNDER CHEROKEE NATION
CODEANNOTATEDTITLE11,CHAPT ER2,SEC11.B:Anapplicantorsponsorwhoknowinglyfilesfalseorfraudulentinformationwill berejected
forenrollmentandmaybesubjecttocriminalprosecution.
_________________________________DONOTWRITEBELOWTHISLINE_________________________________
APPROVED DISAPPROVED
REASON:_____________________________________________________________________________________
_____________________________________________________________________________________
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______________________________
UPDATED(05/18)
 REGISTRAR DATE
CHEROKEENATION
RegistrationDepartment
P.O.Box948
Tahlequah,OK744650948
9184586980
APPLICATIONFORCITIZENSHIP
INTHECHEROKEENATION
(PRINTINBLACK/BLUEINK)
ORIGINALMUSTBEMAILED
CHEROKEEREGISTRYNUMBER
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