CCT Enrollment Application 2022

Enrollment Application Check List

Must be completed by applicant, applicants parent or legal guardian

NOTE: This check list must be submitted with the application form. ONLY COMPLETE APPLICATIONS WITH ORIGINAL EMAILED APPLICATIONS WILL NOT BE ACCEPTED. Make certain all information required is complete on the application form. Any blanks will result in the application being returned to applicant. Enrollment will NOT FILL IN ANY BLANK INFORMATION, including PARENTS ENROLLMENT NUMBER AND DEGREE OF INDIAN BLOOD.

ENROLLMENT APPLICATION CHECK LIST (MUST BE COMPLETED BY APPLICANT. APPLICANT'S PARENT ORLEGAL GUARDIAN)

SIGNATURES WILL BE ACCEPTED. INCOMPLETEAPPLICATIONS WILL NOT BE ACCEPTED. FAXED OR

I certify that all required information is herewith enclosed and complete. I understand that the BURDEN OF PROOF lies with the applicant and it is my responsibility to provide all information/documentation required. I further understand all incomplete applications will not be accepted or processed. I understand that submission of falsified information, forged and/or altered documentation is immediate grounds for denial AND/OR disenrollment.
Copy of Certified Birth CertificateCopy of Applicants Social Security CardPaternity Affidavit (Required if the natural father is the enrolled member OR the Natural father is an enrolled member of another Federally recognized Indian tribe and you wish to include the father's degree of Indian blood to determine applicant's total degree of Indian bloodCertificate of Indian Blood - required when one parent is an enrolled member of another Federally recognized Indian Tribe.REQUIRED- - If either parent is an enrolled member of "another Federally recognized Indian Tribe, you MUST attached a letter from that tribe stating the applicant is not an enrolled member of that tribe and there is no application pending.Family Tree - THIS FORM IS REQUIRED
Signature of Applicant/Parent or Legal Guardian*
Print application then sign
Date*

MonthDayYear
Date
Address*
Received by
Date

MonthDayYear
Date
SUBMIT APPLICATIONS TO: Chippews Cree Tribe, 96 Clinic Rd. N., Box Elder, Mt. 59591 Telephone. NO. - Fax No. 406-895-4591 Chippewa Cree Tribe Tribal Enrollment Department 96 Clinic Rd. N. Box Elder, Mt 59521 Phone: (406) 395-5238
Full Legal Name (First)*
Middle*
Last*
Other Names Used
City & State of birth*
Social Security Number*
Hospital name
Mother blood/quantum*
Father b/q*
Applicant's B/Q*
Physical Address of Parent(s) at time of child's birth CITY*
State*
Zip Code*
City - Current physical and/or mailing address *
State*
Zip Code*
YesNo
YesNo
Is the applicant enrolled or ever been an enrolled member of ANY other Indian Tribe? YES If YES, which tribe? Blood Degree: Has the Applicant relinquished his/her enrollment with this tribe? Yes_ attach an approved resolution relinquishing your enrollment.
If YES, which tribe?
Blood Degree
YesNo
Biological Mother of the Applicant:
First*
Middle*
Last*
Date of Birth*

MonthDayYear
Date
Social Security Number*
Other Names Used
City*
Current Mailing Address*
State*
City*
Current Physical Address*
Zip Code*
State*
Zip: Code*
Primary Phone Number*
Format: (000) 000-0000.
Cell Phone Number*
Format: (000) 000-0000.
Email
example@example.com
YesNo
If YES, which tribe?
Enrollment no.
Blood Degree
YesNo
Is the mother a Veteran or currently serving in the Armed Forces?
If enrolled with a tribe other than the Chippewa Cree Tribe attach a Certificate of Indian Blood (CIB). from the tribe enrolled with.*
Mother's Signature and Date
Please Print the application and then sign Here. (Leave blank and sign after printing the app)
Biological Father of the Applicant:
Name*

First NameMiddle NameLast NameSuffix
Other Names Used
Birthday*

MonthDayYear
Date
Social Security Number*
City*
Current Mailing Address*
State*
Current Physical Address*
Zip Code*
City*
State*
Zip: Code*
Primary Phone Number*
Format: (000) 000-0000.
Cell Phone Number
Format: (000) 000-0000.
SingleMarriedDivorcedWidowed
Email*
example@example.com
YesNo
Enrollment Number
If YES, which tribe?
Blood Degree
Marital Status: Single Married Divorced Widowed Is the Father an enrolled member of ANY Indian Tribe? YES_ NO Enrollment No. If YES, which tribe? Blood Degree: Is the father a Veteran or currently serving in the Armed Forces? *If enrolled with a tribe other than the Chippewa Cree Tribe attach a Certificate of Indion Blood (CIB) from the tribe enrolled with.*
YesNo
Fathers Signature and Date
Please Print the application and then sign and print (do not type name leave blank until printed)
CHIPPEWA CREE TRIBE - ENROLLMENT DEPARTMENT
AFFIDAVIT OF PATERNITY
Childs Name:*

First NameMiddle NameLast Name
FemaleMale
M
F
DATE OF BIRTH*

MonthDayYear
Date
PLACE OF BIRTH*
MOTHER'S MAIDEN NAME*
MOTHER'S ADDRESS*
FATHER'S NAME*
FATHER'S ADDRESS*
Attest
I,*
Applicants Name
Hereby certify that i am the natural father of *
Childs name
DOB*
hereby certify that I am the natural father of

DOB: .I HEREBY CONSENT TO HAVING MY NAME LISTED AS THE NATURAL FATHER OF SAID CHILD AND CONSENT TO THE USE OF MY INDIAN BLOOD TO DETERMINE THE CHILD'S DEGREE OF INDIAN BLOOD.
(Father's printed name)*
Signature*
Please Print the application and then sign the physical copy
Subscribed and Sworn to me this *
Fill in the day of the Month
Day Of*
Fill in the Month
Year*
Fill in the last two digits of the year
Notary public for the State of*
RELEASE OF CONFIDENTIAL INFORMATION

Authorization to the Chippewa Cree Tribal Enrollment Office to obtain and/or release personal information in relation to MY ENROLLMENT AND MY CHILDREN'S ENROLLMENT with the Chippewa Cree Tribe.
Applicants Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

MonthDayYear
Date
Applicant Signature:
Please Print the application and then sign the physical copy
Parent/Guardian Signature:
Please Print the application and then sign the physical copy
DATE*

MonthDayYear
Date
Birth CertificateCIBOther
NOTARY:

On this day of 20 , before me a Notary Public for the State of , personally appeared and , known to me to be the person(s) whose names are subscribed to the within instrument and acknowledge to me that they executed the same.

IN WITNESS THEREOF, I have hereunto set my hand and affixed my notarial seal the day and year first above written.

before me a Notary Public for the State , known to me to be the person(s) whose names are

Notary Public for the State of Residing at My commission expires,

This portion of the application is to be printed then filled out in the presence of a Notary Public
(SEAL)
Residing at
Notary Public for the State of
My commission expires,
Your Name*

First NameLast Name
Father Name*
Mother Name*
Paternal Grandparents*
Please add both grand parents
Maternal Grandparents *
Please add both grand parents
Great Grandparents
Please add both grand parents
Great Grandparents
Please add both grand parents
Great Grandparents
Please add both grand parents
Great Grandparents
Please add both grand parents
Should be Empty:

CHIPPEWA CREE TRIBE - ENROLLMENT DEPARTMENT

AFFIDAVIT OF PATERNITY

RELEASE OF CONFIDENTIAL INFORMATION