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De ar Ho-Chunk Student, Higher Education Division is (Ho-Chunk Nation)

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P.O. Box 667 Black River Falls, WI 54615 • phone: (800) 362-4476 p.1
e-mail: higher.education@ho-chunk.com • fax: (715) 284-1760
De
ar Ho-Chunk Student,
The
Higher Education Division is committed to helping you attain your educational and professional goals. In
order to be considered for a Ho-Chunk Scholarship, you must meet the following requirements:
• Be an enrolled Ho-Chunk member;
• Be interested/accepted/enrolled in pursuing a progressive degree at an accredited Title IV non-profit institutio
n
of higher learning (subject to approval);
• File your Free Application for Federal Student Aid (FAFSA) each academic year;
• Complete the Ho-Chunk Scholarship Application prior to the absolute deadline (first day of classes).
Fund
ing maximums are determined by type of degree program you are interested in and are prorated for
part- time attendance. Funding is determined by standard semester terms, students pursuing coursework online
,
ni
ght classes, or attending quarter based schools; for these particular institutions, your terms will be calculated
into an equivalent semester ratio. To be eligible for federal financial aid you must be in an eligible program
.
The following is needed to complete the funding process:
Timeline
1. Ho-Chunk Scholarship Application (HSA)
Complete one application each academic year
*Academic Year includes both fall term and spring term
Please submit HSA early to allow for processing
time. The higher education division will not process
your HSA after the absolute deadline (first day of
classes)
2. File the Free Application for Federal Student Aid
(FAFSA
)
You may file and/or update online annually at
www.fafsa.gov
3. Acceptance Letter: Technical/two-year campus students
Admission Letter: Four year and graduate students
As soon as possible
4. Submit a copy of your class schedule, include your
name, academic term, school name, and number of
credits
A
s soon as you register
5. Submit a copy of the school’s detailed billing statement As soon as it is posted to your student account
6. Submit a copy of your Financial Aid Award Summary
provided by the school
As soon as it is posted to your student account
7. Official transcript
*Students who previously received funding ONLY
A
s soon as the term ends and grades are posted
8. Submit a copy of your CDIB (Certificate Degree of Indian
B
lood).
As soon as possible
For
more information on funding maximums for a one year technical diploma, Associate degree, Bachelor’s
degree, and graduate funding, please see the our policy at: www.ho-chunknation.com/documents.
Academic Year 2018-2019
P.O. Box 667 Black River Falls, WI 54615 • phone: (800) 362-4476 p.2
e-mail: higher.education@ho-chunk.com • fax: (715) 284-1760
S
tudent Responsibilities
As a participant in the Ho-Chunk Nation Scholarship Program:
1. I agree that participation in this program is strictly voluntary
.
2
. I hereby acknowledge that I have read and fully understand the rules, terms, and conditions of the Higher
Education Scholarship Program Policy and agree to abide by said rules, terms, and conditions. The Higher
Education Division Funding Policy is located at www.ho-chunknation.com/documents.
3. I understand that my failure to comply with all such rules, terms and conditions, currently existing or as
amended or modified, may result in probation or suspension from the Ho-Chunk Scholarship Program
.
4. If I withdraw, drop out, or am expelled from any classes, or if I reduce the initial number of credits, or
classes taken, I must provide written notification to the Higher Education Division immediately. Failure to do
so may result in my probation or suspension with the Ho-Chunk Scholarship Program.
5. If applicable, I understand that it is my responsibility to report the value of my Per Capita Trust Fund (“18
Money”) when I complete my FAFSA, and claim that amount as a financial asset when I file my annual
income tax return.
6. I understand that the Ho-Chunk Nation assumes no responsibility and no liability for any effects that the
Scholarship Program may have on any other funding anticipated or actually received by the participant
,
i
ncluding but not limited to, Welfare, Social Security, Supplemental Security Income (SSI), Medicare, or
other grants, scholarships and/or fellowships provided by any private, state, or federal entities currently
existing or created in the future.
7. I will communicate with education department staff respectfully and conduct myself in a courteous manner.
8. I acknowledge that the funding process may take several weeks to complete, and that it is in my best
interest to apply early. I understand that the Ho-Chunk Scholarship I am applying for cannot be processed
until all supporting documents have been submitted by me.
9. I acknowledge my responsibility for school fees and charges until eligibility is determined, awarded, and
sent to the school
.
Tax Consequences
1. I understand that any educational scholarship I receive from the Ho-Chunk Nation may result in tax
consequences. The Internal Revenue Service (IRS) states that any money I receive is income, although
educational scholarship income may qualify for an exception.
2
. I hereby acknowledge the responsibility for substantiating any deduction of educational scholarship income
rests with the individual taxpayer
.
3
. I also acknowledge that the Ho-Chunk Nation is not liable for any tax consequences which may result from the
distribution of scholarship funds to me.
4. I understand my tax responsibility to claim all HCN Per Capita payments received annually.
NOTE: It is the student’s responsibility to file a tax report annually.
S
TUDENT
R
IGHTS AND
R
ESPONSIBILITIES
Academic Year 2018-2019
H
O-CHUNK NATION SCHOLARSHIP APPLICATION
P.O.
Box 667 Black River Falls, WI 54615 • phone: (800) 362-4476 • email: higher.education@ho-chunk.com • fax: (715) 284-1760
p.3
439A00-
TRIBAL ID NUMBER
LAST NAME
FIRST NAME
MI
PREVIOUS
/
MAIDEN NAME
- -
/ /
□ PHONE □ E-MAIL □ MAIL
SOCIAL SECURITY NUMBER
DATE OF BIRTH
(
MM
/
DD
/
YY
)
GENDER
PREFERRED COMMUNICATION
MAILING ADDRESS (WHILE ATTENDING SCHOOL) CITY
STATE
ZIP
PERMANENT ADDRESS (IF DIFFERENT FROM MAILING ADDRESS)
CITY
STATE
ZIP
(
)
-
PRIMARY PHONE NUMBER
PRINT EMAIL
/
FAFSA FILING DATE (MM/YY) COLLEGE/UNIVERSITY YOU WILL ATTEND COLLEGE/UNIVERSITY LOCATION: CITY/STATE
MARITAL STATUS
NUMBER OF DEPENDENTS
PREVIOUS HIGHER ED FUNDING RECEIVED: □ YES □ NO YEARS: ________________________________________________________
P
ARENTAL INFORMATION:
FATHER’S NAME: _________________________________________
TRIBAL AFFILIATION: __________________________
MOTHER’S MAIDEN NAME: __________________________________
TRIBAL AFFILIATION: __________________________
STUDENT CONSENT & RELEASE OF INFORMATION:
The information given by me on this form is accurate and complete to the best of my knowledge. I give permission for all
information on this form to be shared among the BIA, the Ho-Chunk Nation, the State, and the Financial Aid Office at my
school. I have read and agree to the student rights and responsibilities on page two (2). I acknowledge my responsibility
for school fees and charges until eligibility is determined, awarded, and sent to the school.
To consent to the release of your information to a third party, please notify Higher Education via email at
higher.education@ho-chunk.com
_____________________________________
______________________________________ ______________
Student Signature Student’s Legal Name (printed) Date
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signature
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P.O. Box 667 Black River Falls, WI 54615 • phone: (800) 362-4476 • email: higher.education@ho-chunk.com • fax: (715) 284-1760 p.4
STUDENT PROFILE
To better suit your educational needs, we want to know more about you. Please tell us about your education
goals. Secondly, what are your career goals upon degree completion?
CURRENT YEAR IN SCHOOL/CREDITS EARNED FOR INTENDED DEGREE:
□ FRESHMAN 1-30 □ SOPHOMORE 31-60 □ JUNIOR 61-90 □ SENIOR 91-120 □ GRADUATE # CR. ___ □ NO CREDITS/UNSURE
DEGREE SEEKING:
□ TECHNICAL DIPLOMA/CERTIFICATE □ ASSOCIATE □ BACHELOR’S □ MASTER’S □ JURIS DOCTORATE □ DOCTORATE
PROGRAM/MAJOR :
____________________________________________ EXPECTED GRADUATION DATE:_______________
U.S. VETERAN :
□ NO □ YES, MILITARY BENEFITS: □ STATE □ FEDERAL □ MILITARY DISCOUNT □ PARENT/SPOUSE □ N/A
PRESENT EMPLOYMENT STATUS:
EMPLOYED:
□
YES
□
NO WORK STATUS WHILE ATTENDING SCHOOL:
□
FULL-TIME
□
PART-TIME
□
N/A
HO-CHUNK NATION EMPLOYEE: □ NO □ YES DEPARTMENT:
_____________
________________________ ______________________________________ ______________
Student Signature Student’s Legal Name (printed) Date
Academic Year 2018-2019
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De ar Ho-Chunk Student, Higher Education Division is (Ho-Chunk Nation)

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Completed 23 December 2020

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