Fillable Pokgnek Bodwadmik 2020-2021 Higher Education Assistance Program (HEAP) (Pokagon Band of Potawatomi Indians)

Fill Online, Printable, Fillable, Blank Pokgnek Bodwadmik 2020-2021 Higher Education Assistance Program (HEAP) (Pokagon Band of Potawatomi Indians) Form

Use Fill to complete blank online POKAGON BAND OF POTAWATOMI INDIANS (MI) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Pokgnek Bodwadmik 2020-2021 Higher Education Assistance Program (HEAP) (Pokagon Band of Potawatomi Indians)

On average this form takes 21 minutes to complete

The Pokgnek Bodwadmik 2020-2021 Higher Education Assistance Program (HEAP) (Pokagon Band of Potawatomi Indians) form is 6 pages long and contains:

  • 0 signatures
  • 17 check-boxes
  • 75 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Pokagon Band of Potawatomi Indians

BROWSE POKAGON BAND OF POTAWATOMI INDIANS (MI) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Pokégnek Bodéwadmik
POKAGON BAND OF POTAWATOMI
EDUCATION
1
58620 Sink Road • PO Box • Dowagiac, MI 49047 • www.PokagonBand-nsn.gov
(269) 782-0887 • (888) 330-1234 toll free • (269) 782-0985 fax
2020-2021 Higher Education Assistance Program (HEAP) Application
Deadline: Fall Semester August 1
Deadline: Spring/Winter Semester December 1
Deadline: Summer May 1
Dear HEAP Applicant,
Congratulations on pursing your education. Please read thoroughly for there have been some
changes throughout the application.
To complete the application process for the Pokagon Band Higher Education Assistance Program
every semester, the following items need to be completed, attached, and emailed to the
Department of Education.
No.
Forms Checklist
Completed/Attached
(Circle)
1
I have read the HEAP Policy
Y / N
2
HEAP Application pgs. 1-6 including signatures
Y / N
3
Direct Deposit Form w/voided check or account verification (required for new
applicants or banking updates)
Y / N
4
Copy of FAFSA Student Aid Report - http://fafsa.ed.gov/ (please submit once
per academic year)
Y / N
5
New applicants - high school diploma, or GED certificate
Returning applicants - copy of your college/university UNOFFICIAL
transcript
[Students do not need last semester’s grades to move forward w/HEAP Application]
Y / N
6
Higher Education students submit of official semester class schedule with
credit hours or Vocational students submit a copy of the course plan and cost
invoice
Y / N
7
I am applying for Housing Assistance
Y / N
8
Submit a current copy of dorm/lease/mortgage if you are applying for Housing
Assistance (only needed once per academic year)
Y / N
9
I have submitted a Financial Aid Verification Form to my institution or
attached my semester’s bill to my HEAP Application
Y / N
Email Application and documentation to DOE.HEAP@PokagonBand-nsn.gov
.
Application Signature:______________________________________Date:_______________
Pokégnek Bodéwadmik
POKAGON BAND OF POTAWATOMI
EDUCATION
2
58620 Sink Road • PO Box • Dowagiac, MI 49047 • www.PokagonBand-nsn.gov
(269) 782-0887 • (888) 330-1234 toll free • (269) 782-0985 fax
2020-2021 HEAP Application
Basic Student Information
Name: First______________________Middle___________________Last_________________________
Tribal ID Number:_______________ Date of Birth:__________________
Address:__________________________________City_________________State_____Zip___________
Cell Phone:(______)_________-____________ Email:________________________________________
I am classified as a (circle one): Freshman Sophomore Senior Graduate
I am pursuing the following (circle one):
Certificate Associates Bachelor’s Master’s Doctorate Vocational
My field of study or major:___________________________
My expected date of graduation:_______________________
Other Student Assistance Aid Anticipated this Academic Semester
Michigan Indian Tuition Wavier____________ Pell Grant_______________ Other__________________
College/University/Vocational School Information
I am requesting HEAP (mark box): Tuition □ Book Stipend/Vo-Supplies □ Housing (p.6) □
Name of School: ___________________________________Circle one: Private Public Tribal
Address:________________________________City___________________State_____Zip___________
Student I.D.#:______________________________
Are you attending two or more schools this semester (3 max)? Yes _____ No _____
If yes, an additional HEAP Application will need to be submitted for each school.
I DECLARE THAT THE INFORMATION GIVEN BY ME ON THIS FORM IS TRUE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
Application Signature:______________________________________Date:_____________
Pokégnek Bodéwadmik
POKAGON BAND OF POTAWATOMI
EDUCATION
3
58620 Sink Road • PO Box • Dowagiac, MI 49047 • www.PokagonBand-nsn.gov
(269) 782-0887 • (888) 330-1234 toll free • (269) 782-0985 fax
2020-2021 HEAP Application
Recipient Agreement
I agree to the following items as a condition of receiving the Higher Education Assistance Program:
1. Must use funds for education-related expenses.
2. Must attend the institution listed on the application.
3. Must submit a copy of diploma upon graduation.
4. Must submit a HEAP Application each semester.
5. Must submit college/university unofficial transcript to verify grades.
6. Must maintain a minimum grade point average (GPA) of 2.0 or the minimum standard for the
higher education institution for undergraduate study and 3.0 for graduate study. If the student’s
cumulative grade point average drops below the determined GPA, the student will be placed on
academic probation and must follow the Academic Improvement Plan found in the HEAP Policy.
7. Must notify the Pokagon Band’s Education Department of any changes to the original schedule
submitted. Reduced credit hours must be paid back if you were awarded tuition based off more
credit hours than taken.
8. Withdrawal from school must be pre-approved by the Higher Education Specialist. Student must
notify the Pokagon Band Department of Education within (5) business days after dropping a class
or withdrawing from school completely. The portion of the Pokagon Higher Education Assistance
received for the dropped class must be paid back to the Pokagon Band following the HEAP
Policy.
9. Must maintain current address, telephone number, email address, and other contact information
with the Pokagon Band Enrollment Department.
10. Must scan and email completed application to doe.heap@pokagonband-nsn.gov
. If a student is
unable to email completed application, then submission via mail, drop off or fax (269-782-0985)
is acceptable.
11. Must submit all required paperwork for the semester requesting funding before the following
deadlines to be eligible:
Deadline: Fall Semester August 1
Deadline: Spring/Winter Semester December 1
Deadline: Summer May 1
I understand that failure to abide by these conditions may jeopardize my future HEAP funds.
Application Signature:______________________________________Date:_____________
Pokégnek Bodéwadmik
POKAGON BAND OF POTAWATOMI
EDUCATION
4
58620 Sink Road • PO Box • Dowagiac, MI 49047 • www.PokagonBand-nsn.gov
(269) 782-0887 • (888) 330-1234 toll free • (269) 782-0985 fax
2020-2021 HEAP Application
Proxy/Authorized Account Access
Proxy access allows a student to give someone else (usually a parent or guardian) read only access to
designated portions of a student’s records. Proxies or authorized users can optionally make payments to a
student’s account on the student’s behalf.
All HEAP tuition payments will be paid using proxy access. Please provide login information below or
establish the access through your institution using the email address doe.heap@pokagonband-nsn.gov
as
the user email.
We are not requesting or requiring full access to your student online portal. The username, user email and
password that you use to access your classes, records, etc. is unique to you and should remain private.
Authorized Payment Request Information
Proxy Username: ________________________Proxy Password:______________________
Institutions website/user website:________________________________________________
Mark box if below applies:
□ My school does not offer proxy/authorized user (third-party) accounts.
I DECLARE THAT THE INFORMATION GIVEN BY ME ON THIS FORM IS TRUE AND COMPLETE TO
THE BEST OF MY KNOWLEDGE.
Application Signature:______________________________________Date:_____________
Pokégnek Bodéwadmik
POKAGON BAND OF POTAWATOMI
EDUCATION
5
58620 Sink Road • PO Box • Dowagiac, MI 49047 • www.PokagonBand-nsn.gov
(269) 782-0887 • (888) 330-1234 toll free • (269) 782-0985 fax
2020-2021 HEAP Application
Consent to Release Information
Dear Pokagon HEAP Recipient,
The Family Education Rights and Privacy Act (FERPA) is a federal law that protects the privacy of
student education records. These rights transfer to the student when he/she reaches the age of 18 or
attends a school beyond the high school level.
Now that you are attending college, it is your decision to allow other people access to your student
information.
According to FERPA, we are required to get your written consent to share information with anyone other
than you. Below is a consent form. Please review it and decide with whom-if anyone- we may discuss
your student file. Example given: parent, spouse, partner.
As always, contact our office if you have any questions.
CONSENT TO RELEASE INFORMATION
I, (print name) ________________________________________, give permission to the Pokagon Band
Department of Education to release information regarding my Higher Education Assistance Program file
to the following individual(s) or institution(s).
1.___________________________________________________________________
2.___________________________________________________________________
3.___________________________________________________________________
4.___________________________________________________________________
Mark box if below applies:
□ I do not wish to release my information to any individual(s) or institution(s).
Application Signature:______________________________________Date:_____________
Pokégnek Bodéwadmik
POKAGON BAND OF POTAWATOMI
EDUCATION
6
58620 Sink Road • PO Box • Dowagiac, MI 49047 • www.PokagonBand-nsn.gov
(269) 782-0887 • (888) 330-1234 toll free • (269) 782-0985 fax
2020-2021 HEAP Application
HEAP Housing Assistance
Are you applying for Housing Assistance through HEAP? Yes_____ No_____
If your answer is no, please sign at the bottom of the page. Please note that Housing Assistance is only
available to full-time students.
Housing Assistance Guidelines:
• May be used to pay the student’s mortgage, rent, or boarding, etc.;
• Shall not be used to pay rent, directly or indirectly, to any parent, custodian, or guardian of the
student unless the rental unit is wholly self-contained (completely separate amenities – kitchen,
bathroom, etc.) and the parent, custodian or guardian does not reside at the rental unit; and
• May be used to pay rent to a family member other than a parent, custodian or guardian.
Please complete the information below:
Have you read and do you acknowledge, the Housing Assistance guidelines listed above?
Yes_____ No_____
Address where you will be residing while you’re in school:
Apartment/House/Dorm: ______________________________________________________
Street______________________________City_______________State_____Zip__________
If you are a full-time student and interested in applying for housing, please submit your rental agreement
or dorm contract with this application. The lease or dorm agreement must not be expired. If you are at the
same residence but are under a month-to-month agreement, please submit a letter from the
landlord/apartment complex stating the month-to-month change to the lease.
Application Signature:______________________________________Date:_____________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Pokgnek Bodwadmik 2020-2021 Higher Education Assistance Program (HEAP) (Pokagon Band of Potawatomi Indians)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document