NATIVE VILLAGE OF GEORGETOWN TRIBAL ENROLLMENT

NATIVE VILLAGE OF GEORGETOWN TRIBAL ENROLLMENT
Full name of person completing the enrollment form
Please fill out the section below for each individual you wish to enroll. Adults, please fill out and sign a separate form for each individual adult applying for enrollment and include any children you wish to enroll in sections 2-4. If the enrollee is under 18, his or her parent or legal guardian must sign the Tribal Enrollment form.
1. Full Name of Person Being Enrolled
Date of Birth

MonthDayYear
Date
Social Security #
FemaleMale
Mailing Address
Home Phone
Work Phone
Cell Phone
Email Address
example@example.com
Mother's Full Name
Father's Full Name
Alaska Native

YesNo
Are you currently enrolled in another tribe?

YesNo
If yes, name of Tribe
2. Full Name of Person Being Enrolled
Date of Birth

MonthDayYear
Date
Social Security #
Type a question

MaleFemale
Mailing Address
Home Phone
Work Phone
Cell Phone
Email Address
example@example.com
Mother's Full Name
Father's Full Name
Alaska Native

YesNo
Are you currently enrolled in another Tribe?

YesNo
If yes, name of Tribe
3. Full Name of Person Being Enrolled
Full Name of Person Being Enrolled
Date of Birth

MonthDayYear
Date
Social Security #
Type a question

MaleFemale
Mailing Address
Home Phone
Work Phone
Cell Phone
Email Address
example@example.com
Mother's Full Name
Father's Full Name
Alaska Native

YesNo
Are you currently enrolled in another tribe?

YesNo
If yes, name of Tribe
Full Name of Person Being Enrolled
Date of Birth
Social Security #
Type a question

MaleFemale
Mailing Address
Home Phone
Work Phone
Cell Phone
Email Address
example@example.com
Mother's Full Name
Father's Full Name
Alaska Native

YesNo
Are you currently enrolled in another tribe?

YesNo
If yes, name of Tribe
By signing the Tribal Enrollment Form, you are certifying that the enrollee is an original Georgetown member, a natural child of an original Georgetown tribal member, a natural child of a descendant of a Georgetown tribal member or has been adopted by an original member or descendant of an original member.

All new enrollees of Georgetown are required to provide a copy of their birth certificate which will be kept on file at the Georgetown Tribal Council office. If the enrollee has been adopted by an original members or a descendant, please provide either legal adoption papers or certification of native traditional adoption. New enrollee forms cannot be processed without the copy of the birth certificate, signature, and appropriate paperwork attached.
Signed

Clear
Dated

MonthDayYear
Date
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