Fillable Form -12: Secondary School Incentive Program (Delaware Nation)

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Form -12: Secondary School Incentive Program (Delaware Nation)

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Education Form 001 Revised December 2019
Secondary School Incentive Program
The Secondary School Incentive program is for enrolled Delaware Nation children in the 5
th
-12
th
grades that meet the program criteria. The Program is on a first come first serve basis as funds
are available.
REQUIREMENTS
Must be an enrolled Delaware Nation citizen
High School Students in 9
th
– 12
th
grades must maintain a 3.0 GPA or above and have no more
than 5 absences per semester
Students in 5
th
– 8
th
grades cannot receive a letter grade lower than a “C” and have no more
than 5 absences per semester
REQUIRED DOCUMENTS
A copy of the student’s report card with semester grades only. Please do not submit a report
card with quarterly (9 week) grades; the application will be placed on pending status until the
correct information is received.
Applications can be mailed, faxed, emailed or brought to the Social Services office
A brief essay stating (page 3)
Applicant’s name and grade
Applicant’s age
What their favorite subject/class was and why
How funds will be used (i.e., clothing, games, school annuals, class pictures etc.)
APPLICATION
FALL SEMESTER: Students can start submitting fall grades by January 1
st
SPRING SEMESTER: Students can start submitting spring grades by June 1
st
ACADEMIC YEAR: August 31
st
is the deadline date for late fall and spring requests for the whole
academic school year.
SERVICES AREA
Nationwide
Semester Award
GRADE
FALL
SPRING
GPA
5
th
– 8
th
Grade
$100.00
$100.00
No grade lower than a “C”
and no more than 5
absences a semester
9
th
– 12
th
Grade
$200.00
$200.00
3.0 – 4.0 and no more than
5 absences a semester
Education Form 001 Revised December 2019
Secondary School Incentive Application
Student Information
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
ZIP Code
Home Phone:
( )
Social Security Number:
Roll Number:
Age:
Name of Parent/Legal
Guardian
Other Information
Please attach a copy of semester grades, attendance record and essay to application
School Information
School:
Circle
one
Fall or Spring
Address:
Year:
GPA:
Grade
5
th
GRADE
9
th
GRADE
6
th
GRADE
10
th
GRADE
7
th
GRADE
11
th
GRADE
8
th
GRADE
12
th
GRADE
I hereby certify that this application is true to the best of my knowledge. It is my responsibility to submit a copy
of my semester grades and CDIB card to the Delaware Nation Education Department office.
OFFICE USE ONLY
Approved
Denied
PRINT Parent/Guardian Name
Date
Signature (Parent Guardian)
Education Department Signature
Date
Delaware Nation
Educaton Program
P.O. Box 825
Anadarko, OK 73005
Phone (405)247-2448 Fax (405)247-
5942
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Education Form 001 Revised December 2019
ESSAY MUST BE WRITTEN BY STUDENT
Student Signature Date
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Form -12: Secondary School Incentive Program (Delaware Nation)

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Completed 20 July 2020

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