2020 SUMMER
HO-CHUNK SCHOLARSHIP
Complete in ink. Incomplete and/or illegible applications will be returned to the student.
Tribal ID Number Last Name First Name MI Previous/Maiden Name
□ Male □ Female □ Other □ Phone □ E-mail □ Mail
Social Security Number Date of Birth (mm/dd/yy)
Gender
Preferred Communication
Mailing Address (while attending school)
City
State Zip
Permanent Address (if different from mailing address)
City
State Zip
Primary Phone Number
Alternate Phone Number Print E-mail
FAFSA Filing Date (mm/yy) College/University you will attend College/University location: City, State
Current year in school/credits earned for intended degree:
□ Freshman 1-30 □ Sophomore 31-60
□ Junior 61-90 □ Senior 91-120 □ Graduate # cr. ____ □ No Credits/Unsure
Degree Seeking: □ Technical Diploma/Certificate □ Associate □ Bachelor’s □ Master’s □ Juris Doctorate □ Doctorate
U.S. Veteran : □ Yes □ No Military Benefits:
□ State □ Federal □ Parent/Spouse □ Tuition Discount
Present Employment Status:
Employed: □ Yes □ No Work status while attending school: □ Full-time □ Part-time
Current Ho-Chunk Nation Employee: □ No □ Yes Department: Division:
I understand that it is my responsibility to report changes regarding my contact information (address, phone and e-mail)
enrollment status, and changes to my financial aid to the Highered.education@ho-chunk.com student e-mail. __________ Initial
Additional information needed for Ho-Chunk Summer Scholarship consideration:
Valid class schedule (must show student name, school name, course title, credits and
term)
Itemized summer billing statement from the school (electronic or paper copy)
Copy of the financial aid award letter from the school (electronic or paper copy)
Provide an official grade transcript (to close out previous funding) to determine eligibility
Provide an acceptance/admission letter
Copy of CDIB (Certificate Degree of Indian Blood), if not previously provided
Student Consent & Release of Information
The information given by me on this form is accurate and complete to the best of my knowledge. By signing this application
I am granting permission for my post-secondary institution or my prospective institution to share my information,
including STUDENT FAFSA RECORD INFORMATION to the Ho-Chunk Nation Higher Education Division. I give
permission for my financial aid and academic information to be shared among the following funding agencies: Bureau of Indian
Affairs, Ho-Chunk Nation, State, the Financial Aid Office, and Academic Advisors at my school. I understand I may be
required to complete a separate release of information for any additional inquires.
Signature of Applicant
Student’s Legal Name (printed) Date
Higher Education Division
P.O. Box 667
Black River Falls, WI 54615
(800)
362-4476
fax: 715-284-1760
higher.education@ho-chunk.com
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