College Incentive Application - CAHIE Scholarship Program

Date of Application

Date

What academic year are you applying for?

This application is intended for the following supplemental assistance. Please check one.

STUDENT’S NAME

DATE OF BIRTH

SEX

INSTITUTION NAME

CLASSIFICATION

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PHONE NUMBER

Format: (000) 000-0000.

EMAIL ADDRESS

example@example.com

TRIBAL ROLL

The Cheyenne and Arapaho Tribes has a contract with the Bureau of Indian Affairs Higher Education Assistance Program which operates under the general authority of 24 USC Chapter 13, 42 Stat. 208 P.L. 67-85 with specific legislation contained in 25 USC, Subchapter E, Part E. Administration of Educational Loans, Grants, and Other Assistance for Higher Education. In accordance with the accountability required for the Administration of the funds appropriated for the program and in order to provide services to recipients, and to declare eligibility, certain information is needed of applicants. This form solicits the required information. Use of personal data will be available to authorized sources upon request. The applicant should understand that the intent of collecting and maintaining this data on individuals is for determining eligibility of the applicant and to provide the means for producing certain statistical records 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 statement of privacy listed with this application form. I hereby provide the required information and authorize the use of such information to the extent of the uses specified in the statement.

Date

Please call our office for any questions:

Mailing Address: Higher Education Program, PO Box 167, Concho, OK 73022

Email Address: HigherEd@cheyenneandarapaho-nsn.gov

Phone Number: 405-422-7646

Fax Number: 405-422-8211

CAHIE Scholarship Program

STATEMENT OF PRIVACY