Section B: YOUR COURSE OF STUDY - YOU MUST COMPLETELY FILL OUT THIS SECTION
Type of Institution (Check ALL that apply):
University Community Vocational Diving Online
Name of Institution:___________________________________________________________________________________________________________________
Term You Are Applying For (check one):
Quarter Semester Session
Degree/Certificate You Plan to Receive (check one):
Certificate or Diploma for completing an occupational, technical,
or educational program (less than two-year program)
Certificate or Diploma for completing an occupational, technical,
or educational program (at least two-year program)
Associate’s Degree (at least two-year degree)
Bachelor’s Degree
Teaching Credential Program (non-degree program)
Graduate or PhD Degree
GED / High School Diploma
Other / Undecided
Month/Year you plan to earn your degree:______________________
Number of Credits:______________________ Check One:
Full-Time Part-Time
Course of Study (major):___________________________________________________
Name of Academic Counselor:______________________________________________
Telephone Number:_______________________________________________________
Email:___________________________________________________________________
Release of Information (person you would like us to discuss your information with, for example – mom, dad, or sibling):
_____________________________________________________________________________________________________________________________________
Name - Relationship - Telephone Number - Email
Section A: STUDENT INFORMATION
Last Name: First Name: Middle Name: Tribal I.D. Number: Today’s Date:
Permanent Mailing Address:
_____________________________________________________________________________________________________________________________________
Street - P.O. Box - City - State - Zip
Date of Birth: Best Contact Number: Message Number: Email: School/Student I.D. Number:
Section C: RELEASE OF INFORMATION / PUBLIC DISCLOSURE
I understand and agree that if I receive funds for education purposes under the supervision of the Tulalip Education Dept., the Department will publish in the
See-Yaht-Sub my name and the name of the educational institution I am attending as a matter of tribal public disclosure. My grades and grade point average
will not be published unless I agree in writing to allow such a publication. I have read , under-stand and accept my rights and responsibilities of the Higher
Education Policy as passed by the Board of Directors.
I also understand and agree that the Education representative of the Tulalip Education Dept. have my permission and release to obtain my student files,
including grades, from the educational institution and other tribal entities that I am attending and may provide that confidential information only to Tulalip
Education Dept. officials, tribal entities to which may be helpful to my education, and the Tulalip Board of Directors.
Student Signature:_________________________________________________________________________________ Date:_____________________________
TULALIP TRIBES HIGHER EDUCATION FUNDING PROGRAM APPLICATION
6406 Marine Drive • Tulalip, WA 98271 • 360 716-4888 • 360-716-0398(Fax) • highered@tulaliptribes-nsn.gov
Higher Education
click to sign
signature
click to edit
![]()
