Scholarship Application

Personal Letter
Formal Personal Letter requesting funding from the tribe. The letter should include your major plan of study, goals, plans after leaving school and intended date of graduation.
Personal Letter:*

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Agreement
Name*

First NameLast Name
am applying for a Scholarship for the:
Year*
Term*
I agree to abide by the required rules and regulations set forth by the Eastern Shoshone Education Program and the Shoshone Business Council.

I also understand that the scholarship award is subject to the availability of funds and the amount is subject to change by the Shoshone Business Council. If I do not continue the Semester/Quarter/Academic Year/Training for which I am funded or do not meet standards, the scholarship will be converted into a LOAN.

I will contact and submit an explanation in WRITING to the Eastern Shoshone Education Program indicating my reason(s) for withdrawing from school or dropping courses within 30 days of the last day classes were attended. I understand a request of waiver for repayment may be requested and that the decision of the Shoshone Business Council is FINAL.

If a student fails to voluntarily pay back the approved and funded amount of the awarded scholarship, then the Shoshone Business Council will take action to deduct said amount from the Shoshone Tribal Individual Monies (Welfare Benefit) and/or payroll.

I understand entirely the requirements and conditions of the Scholarship and certify that the information on the application is correct, true and submitted with my approval.
**PLEASE READ AND INITIAL THE FOLLOWING REQUIREMENTS IF YOU AGREE TO FOLLOW THEM ENTIRELY**
I agree to maintain a 2.0 or better GPA each semester/quarter that I attend college.*
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I agree to maintain 12 or more credit hours as a full-time student each semester/quarter or complete ALL approved credit hours as a part-time student or graduate student. *
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I agree to contact the Eastern Shoshone Education Program in WRITING if I decide to withdraw from school or drop classes. No contact can result in suspension from the program.*
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I assume full repayment of the Eastern Shoshone Education scholarship award to the Eastern Shoshone Education Program should a withdraw occur or I do not maintain the required GPA and credit hours.*
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I agree to submit final grade reports or an official transcript from the college that I am attending at the end of each semester/quarter. Failure to do so will result in the scholarship becoming a LOAN.*
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I agree to not use social media services or sites, or any other websites, to disparage the Eastern Shoshone Education Program. As a scholarship recipient I may not harass, bully or intimidate others. Behaviors that constitute harassment and bullying include, but are not limited to, comments that are derogatory with respect to race, religion, gender, sexual orientation, color, or disability; sexually suggestive, humiliating, or demeaning comments.*
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I agree to not post any material that is obscene, defamatory, profane, libelous, threatening, harassing, abusive, hateful or embarrassing to the Eastern Shoshone Education Program when posting to or accessing any social media site. *
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I agree to the Appeal Process (in the handbook).*
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****PAYMENT PLAN: A payment plan must be made with the Eastern Shoshone Education Program within 30 days after my withdraw from school or suspension from the program. Failure to do so will result in a suspension of future funding and Shoshone Tribal Individual Monies (Welfare Benefit) and/or payroll deductions until said amount is repaid in full.

I HAVE READ THE ABOVE STATEMENT(s) REGARDING THE ACCEPTANCE AND USAGE OF THE EASTERN SHOSHONE EDUCATION SCHOLARSHIP AND I UNDERSTAND THE POLICIES AS THEY APPLY TO ME AND THE CONSEQUENCES NOTED.
Date*

MonthDayYear
Date
Signature*

Clear

Release of Information
Name*

First NameLast Name
Last 4 digits of Social Security#*
Student ID#
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
I authorize the Eastern Shoshone Education Program to release necessary records regarding my financial funding or educational progress to:
Name of College*
Signature*

Clear
Date*

MonthDayYear
Date
I, First Name* Last Name* authorize College* to release necessary records regarding my financial funding and educational progress, including transcripts to the Eastern Shoshone Education Program. I understand my rights under FERPA and am giving my consent to release information to the Eastern Education Program.
Signature*

Clear
Date*

MonthDayYear
Date
If under 18, a parent/guardian must sign below:
I Parent Name the parent/guardian of the above mentioned student have read this document and authorize the release of necessary records regarding financial and educational progress to the Eastern Shoshone Education Program.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
I authorize the Eastern Shoshone Education Program to release necessary records regarding my financial progress or educational progress to: Parent/Guardian
Signature

Clear
Date

MonthDayYear
Date

Privacy Statement
Name*

First NameLast Name
The Privacy Act of 1974 required each federal agency that maintains a system of information on individuals as to:

1. The authority, whether granted by statute, or by executive order of the President, which authorizes the solicitation of the information and whether disclosure of such information is mandatory or voluntary.

2. The Principle purposes(s) for which the information is intended to be used.

3. The routine use which may be made of the information, as published pursuant to paragraph (4) (d) of this subsection; and

4. The effect on him/her, if any, of not providing all or any part of the requested information.

The Bureau of Indian Affairs Higher Education Assistance Program operated under general authority of 24 USC chapters, 42 STAT.208PL 67-85 with specific legislation contained in 25USC, subchapter E, part 32, administration of educational loans, grants and other assistance for higher education. In accordance with the accountability for the administration of funds appropriated for the program and in order to provide service to recipients, and to declare eligibility, certain information is required of applicants. This form solicits the required information. Use of personal data will be available to authorized sources upon request. The applicant should understand eligibility of the applicant and to provide the means for producing certain statistical record required of this office. Failure on the part of the applicant to provide the requested information will preclude the applicant from eligibility in obtaining higher education assistance under this program.

I have read the Privacy Statement listed with the application form. I hereby provide the required information and authorize the use(s) of such information to the extent of the use(s) specified in the statement.
Date*

MonthDayYear
Date
Signature*

Clear

Financial Needs Analysis
TERM(S) APPLYING FOR: 20 -20 Academic Year or 20 Semester Quarter*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Student ID
Type a question*

FreshmanSophomoreJuniorSeniorGraduate
Signature*

Clear
Date*

MonthDayYear
Date

FAFSA Confirmation Page: All student must apply for the Free Application For Federal Student Aid (FAFSA) no later than six (6) weeks prior to the first day of class, regardless of whether they qualify or not. It can be accessed and submitted online at www.fafsa.ed.gov. The FAFSA will determine if you are eligible for a Pell grant or work study. You may complete the FAFSA as early as October 1st. Our office requires the confirmation page that shows the student had applied successfully. Please upload the FAFSA Confirmation Page here:

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Letter of Acceptance: Upload your letter of acceptance here. New students must submit a letter of acceptance from the school they are planning to attend. If a continuing student changes schools they must submit a new letter of acceptance from the new school.

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Detailed Class Schedule: Upload your detailed class schedule here. It must include the dates, times and credits.

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Program of Study: Upload your Program of Study here. Which consists of courses required to complete a specific degree.

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High School Diploma or GED: Upload a copy of your high school diploma, GED or college transcripts from the last school you attended.

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Picture Identification: Driver's licenses, or state ID cards for non-drivers, issued by a state's Department of Motor Vehicles. Company-issued ID cards; Passports, or Passport cards.

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Certificate of Indian Blood (CIB) from the Shoshone Enrollment Office. They can be contacted at (307) 332-3908.

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Scholarship Application

Personal Letter

Agreement

Release of Information

Privacy Statement

Financial Needs Analysis