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Dear Ho-Chunk Student, The Higher Education Division is

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P.O. Box 667, Black River Falls, WI 54615 • 1-800-362-4476
e-mail: higher.education@ho-chunk.com • Fax: 715-284-1760
p.1
Dear 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 institution
of higher learning (subject to approval);
• Properly File a 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).
Funding 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,
night 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
As 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
*Only students who previously received funding
As soon as the term ends and grades are posted
8. Submit a copy of your Certificate Degree of Indian Blood
(CDIB).
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: edu.ho-chunknation.com/highered.
Academic Year 2019-2020
P.O. Box 667, Black River Falls, WI 54615 • 1-800-362-4476
e-mail: higher.education@ho-chunk.com • Fax: 715-284-1760
p.2
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 edu.ho-chunknation.com/highered.
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.
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,
including 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.
STUDENT RIGHTS AND RESPONSIBILITIES
Academic Year 2019-2020
Ho-Chunk Nation Scholarship Application
P.O. Box 667, Black River Falls, WI 54615 • 1-800-362-4476
e-mail: higher.education@ho-chunk.com • Fax: 715-284-1760
p.3
439A00-
Tribal ID Number
Legal Last Name
MI
Previous/Maiden name/AKA
- - / /
□
Male
□
Female
□
Other
□
Phone
□
E-mail
□
Mail
Social Security Number
Date of Birth (MM/DD/YY)
Preferred Communication
Mailing Address (while attending school)
City
State
Zip
Permanent Address (if different from mailing address)
City
State
Zip
(
)
-
Primary Phone Number
Print E-mail
/
FAFSA Filing Date (MM/YY) College/University you will attend College/University location: City/State
Completion of 2017 Income Tax Filing? □ Y □ N
Marital Status Number of Dependents
Previous Highered funding received: □ Y □ N List Years: ________________________________________________
I have read and agree to the student rights and responsibilities, which include my responsibility to file the appropriate tax filing
requirements listed on page two (2). I acknowledge my responsibility for school fees and charges until eligibility is determined,
awarded, and sent to the school.
□
Y
□
N
Parental 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. By signing this application I am
granting permission for my post-secondary institution or my prospective institution to share my information, including STUDENT
FAFSA RECORD INFORMATION to the Ho-Chunk Nation Higher Education Division. I give permission for my financial aid and
academic information to be shared among the following funding agencies: Bureau of Indian Affairs, Ho-Chunk Nation, State, and
the Financial Aid Office of my school. I understand I may be required to complete a separate release of information for any
additional inquiries.
____
_________________________________ ______________________________________ __________________
Student Signature Student’s Legal Name (printed
)
Date
Academic Year 2019-2020
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signature
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P.O. Box 667, Black River Falls, WI 54615 • 1-800-362-4476
e-mail: 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. ___
Degree Seeking:
□ Technical Diploma/Certificate
□ Associate
□ Bachelor’s □ Master’s □ Juris /Doctorate □ Doctorate
Program/M
ajor :
____________________________________________
Expected Graduation Date: ____________
U.S. Veteran :
□ N □ Y Military Benefits: □ State □ Federal □ Military Discount □ Parent/Spouse □ N/A
Present Employment:
Employed:
□
Y
□
N Work Status While Attending School:
□
Full-time
□
Part-time
□
N/A
Ho-Chunk Nation Employee: □ N □ Y D
epartment:
_____________________________________ ______________________________________ ______________
Student Signature Student’s Legal Name (printed) Date
Academic Year 2019-2020
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Dear Ho-Chunk Student, The Higher Education Division is

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Completed 22 December 2020

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