Form no. 05042 CH-HC Rev. 8/2017
Rosetta Stone Application
Rosetta Stone Chickasaw is made available for citizens of the Chickasaw Nation and their immediate family
members, as well as employees of the Chickasaw Nation and the general public. For citizens and employees: once
applicant's citizenship* and/or employment status have been verified, an automated email will be sent with additional
instructions on completing the application and licensing process. There is an associated cost for employees and the
general public.
Applicants who are neither citizens nor employees will also receive an automated email with additional instructions on
completing the application and licensing process.
This new educational tool is being developed exclusively for the Chickasaw Nation and will feature custom content
enabling its more than 60,000 global citizens to be introduced to their heritage language. A total of 160 lessons will
be jointly created by language leader Rosetta Stone and leaders from the Chickasaw Nation.
Rosetta Stone Chickasaw is delivered via the award-winning language learning web-based platform from Rosetta
Stone. Rosetta Stone Chickasaw is now available through the Rosetta Stone Advanced Languages app, available on
the iTunes and Android stores, for mobile devices and tablets. The technical requirements for use are: 1.) Unique
email address for all users; 2.) Computer with Internet connection; 3.) USB headset with microphone and 4.)
One of the supported browsers (Chrome, Firefox, Safari, Edge); 5.) Apple/Android smartphone or tablet with
data plan or Wi-Fi connectivity.
Applicant name:
First Middle Last Suffix
Birth date: I am a:
Chickasaw Citizen
Chickasaw family member
Chickasaw Employee
Other
Phone: Email:
Mailing address:
Street City State ZIP
Physical address:
same as mailing
Street/Unit # City State ZIP
Immediate family members for Chickasaw citizens
Name (first, middle, last
and suffix)
Relationship
to applicant
Email address
(each member must have their
own email to participate)
Chickasaw Chickasaw
Citizen family member
(check the box that applies to
each member)
Signature of applicant Date
* Citizenship will be verified
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Please complete and return the application to:
The Chickasaw Nation
Chickasaw Language Revitalization Program
P.O. Box 1548, Ada, OK 74821
Phone: (580) 436-7272 Fax: (580) 272-5383
