Yakama Nation Full-Time Student Distribution Application
Section 8 Use of NET Gaming Revenue; Enrolled Full-Time Students: The Tribal Council hereby allocates SEVEN AND
HALF PER CENT (7.5%) of Net Gaming Revenue to provide funding for FULL-TIME Students to assist with clothes,
and/or expenses. DEFINITION:
Full-time
Student means enrolled Yakama Nation Tribal members, who are enrolled
and attending pre-school through twelfth grade or who are enrolled and attending
full-time
in any post secondary
educational institution. REQUIRED: Age three for entire funding quarter or older, complete application, student’s
Yakama Certificate of Indian Blood (CIB) or Yakama Nation identification, Yakama Nation Tribal member lega guardian’s
current identification, and school proof (
ATTENDANCE RECORDS for pre-school -12
th
; GRADES for higher education).
QUESTIONS: Call 509-865-5121, extension 4419, 4420, 4421 or 4424; fax 509-865-2331; email
fts_rap@Yakama.com. LOCATION/ADDRESS: YN Agency, Attn: RAP, Rm. 126, POB 151, Toppenish, WA 98948.
Applicant Information:
Application Purpose (check box): New Address Change Legal Guardian Change School Change Other:____________
Student’s Grade Level (Check One): Pre-school K thru 8
th
9
th
Thru 12
th
College
Student’s Name:
Students Date of Birth: Student’s US-SSN: Student’s Yakama Enrollment #:
*LEGAL GUARDIAN’S NAME
(PAYEE for minor under
18):
Guardian’s Date of Birth: Guardian’s US- SSN: Guardian’s Yakama Enrollment #:
Current Mailing Address
(City, State, & Zip):
Home Phone: Cell Phone: Work Phone (Ext.):
Email Address: Fax number:
Pre-School – 12
TH
GRADE and GED Information (highlighted area optional):
School Attending: Grade Level:
School Address:
City: State: Zip Code:
Phone: E-mail: Fax:
College, Other Higher Educational Institutions (highlighted area optional):
Grade Level (Check one): ( ) Freshman ( ) Sophomore ( ) Junior ( ) Senior ( ) Graduate/Masters/Doctorate
Higher Educational Institution Name:
Address:
City: State: Zip Code:
Phone: Email: Fax:
Signature (read, check boxes, sign and date):
I certify that all information submitted in the Full Time Student process –including application, W-9,
certificate of Indian blood, current identification, and supporting educational materials-is my own, factually true,
and honestly presented. I authorize review of my application for the Full Time Student distribution indicated on
this form. I understand that I may be subject to a range of disciplinary actions, including full time student
revocation or expulsion, should the information I’ve certified be false.
I acknowledge that I have reviewed the application instructions for this application. I also affirm that I agree
and will send attendance and/or grades which ever applies to me for each quarter.
APPLICANT and /or LEGAL GUARDIAN SIGNATURE REQUIRED: DATE:
*Proof of Legal Guardianship is required if not parent.
