Fillable Educational Services/Assistance Application Education Division Saint Regis Mohawk (St Regis Mohawk Tribe)

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Educational Services/Assistance Application Education Division Saint Regis Mohawk (St Regis Mohawk Tribe)

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Educational Services/Assistance Application
Education Division
Saint Regis Mohawk Tribe
APPLICANT INFORMATION
Applicant Name: ___________________________________________ Date: _______________
Date of Birth: _____________________________ Enrollment #: ________________________
Address: ______________________________________________________________________
City: __________________________ State: _______________ Zip Code: __________________
Home Phone: _________________ Cell: __________________ Work: ____________________
SCHOOL INFORMATION
Name of School: ________________________________________________________________
Grade or College Level: ___________________________________________________________
What type of assistance are you requesting?
Training
Educational Enrichment Activity
Conference related fee
Internship
College visit
Other
If applicable, what is the Title of the event that you wish to attend?
______________________________________________________________________________
When is the date of the event/activity that you are requesting assistance for: _____________
Please describe the reason you are requesting assistance from our program:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Have you received funding from our Division in the past year? Yes No
If yes, please describe:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please note: By submitting this application, you are attesting that you are requesting assistance
from the Saint Regis Mohawk Tribe’s Education Division. You understand that this assistance is
not continual nor is it an avenue that should be sought out every year. This assistance is
conditional and based upon the availability of funds.
Applicant’s Rights and Responsibilities:
I have read this application in its entirety or it has been read to me. I have willingly completed
this application and truthfully answered the indicated questions. I authorize the SRMT Education
Division staff to make any investigation necessary to verify the answers given, and to obtain
information required to determine eligibility for assistance. By signing below, I certify the above
to be true, complete, and accurate.
________________________________________ ________________________________
Signature of Applicant Date
Educational Services/Assistance Application Policies
Submit the original completed Educational Assistance Application, with
department authorization, to the Executive Director of Education at least 60 days
prior to the start date of the event.
Notification will be sent to the applicant within 15 days of SRMT Education
Division receipt of the application, indicating if the request was approved or
denied.
Notification will be sent to the applicant within 15 days of SRMT Education
Division receipt of the application, indicating if the request was approved or
denied.
•
•
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Mail Application to:
SRMT Education Division
412 State Route 37
Akwesasne, NY 13655
518-358-2272
Office Hours:
Monday-Friday 8:00 a.m. to 5:00 p.m.
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Educational ServicesAssistance Application Education Division Saint Regis Mohawk (St Regis Mohawk Tribe)

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Completed 20 July 2020

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