TC Approved on 6-22-18 VM
Santa Rosa Band of Cahuilla Indians
Public or Private Universities
Higher Education Assistance Request Form
Please check only one box below
□ Tribal Member Request
I ________________________, a Tribal Member of Santa Rosa Band of Cahuilla Indians, am
requesting Education Assistance. I am requesting $____________ to pay for tuition, books,
supplies, I have attached copies of my class schedule, receipts, and/or bills. I understand that the
total amount allowed per calendar year is $2,000.00. I understand that I must complete the
classes which I have accepted Education Assistance and forward a copy of my grades, transcripts
or certificate of completion at the end of each semester. I understand that if I don’t comply with
these standards the tribe reserves the right to have me repay this Education Assistance from my
RSTF Distributions at increments of $250.00 until repaid in full.
□ On Behalf of Student Request
I ________________________________, a Tribal Member of Santa Rosa Band of Cahuilla
Indians, am requesting on behalf of my student, ______________________who has graduated
High School, but not yet eligible for Tribal Membership due to birthday being later in the year,
after college school enrollment has commenced, am requesting for Education Assistance. I am
requesting for $ _______________ to pay for tuition, books, supplies, etc. I have attached copies
of student’s class schedule, receipts, and/or bills. I understand that the total amount allowed per
calendar year is $2,000.00. I understand that my student must complete the classes which
he/she has accepted Education Assistance and forward a copy of their grades, transcripts or
certificate of completion at the end of each semester. I understand that if I don’t comply with
these standards the tribe reserves the right to have me repay this Education Assistance from my
RSTF Distribution at increments of $250.00 until repaid in full or until my student is eligible for
tribal recognition and able to pay back through their own RSTF Distribution. I acknowledge that
once my student is eligible for tribal recognition that it will be their responsibility to fill out their
own Higher Education Assistance Request Form which at that time relieves me as the Tribal
Member of any liability to the Tribe.
Tribal Member: _______________________________________ Date: _________________
Student (if applicable): ___________________________________ Date: _________________
Phone Number: _______________________________________
click to sign
signature
click to edit
click to sign
signature
click to edit