ONC Higher Education

ONC Higher Education Quyana for your interest in ONC s Education, Employment & Training Programs. In order to determine eligibility, you must submit the following: A fully completed, signed, and dated 102-477 application. Proof of your age: Birth Certificate, State ID, or Driver s License. A readable copy of: ONC Tribal ID card; a Certificate of Indian Blood (C.I.B.) High school transcripts and previous postsecondary transcript, or GED (General Education Degree) Proof of Income (students attending programs from 6 months to 2 years only): Include last year s Federal Income Tax returns (form 1040) or most recent pay stubs, SSI, child support documents, TANF, unemployment stubs, Alaska permanent fund, current bank statements. A letter from you, expressing your goals and your need for financial aid. Please include the following in your letter; 1) Higher education or training desired; 2) Start date of training; 3) Academic year & grade or rank in college; 4) Whether you ll be attending college part-time/full time 5) Semester you are applying for (fall, spring) and expected date of graduation; 6) For those attending a training program, include a detailed budget of all training expenses. Letter of Acceptance from the college/university or training school.. If you are under 21 years of age and plan to attend school out of state, a letter of consent from your parents or legal guardian is required. If you are under 19 years of age and plan to attend school in Alaska, a letter of consent from your parents or legal guardian is required. Veterans, please provide copies of your Discharge paper work. Males 18 years of age must provide proof of filing with the Selective Service. If you have already filed with the selective service but lost your card, please call toll-free 1(847) 688-6888 for a replacement card. Students attending school Out-of-State are encouraged to set up a health care contract with the Indian Health Service. Contact Juanita Treat at the Yukon Kuskokwim Delta Regional Hospital at 543-6350. A copy of your Student Aid Report (SAR). This is a reply from the Federal Student Aid Report (FAFSA). All students are required to apply for Federal Student Aid, on line at www.fafsa.ed.gov, Pick one up an initial application at your local campus. ONC s Budget Forecast & Needs Analysis. Mail the form to your college or university s Financial Aid Office after you have applied for federal student aid. The financial aid office will return the form back to us. Proof of your financial resources. This would be a copy of your last Pay stub/pay check, or your last month s bank statements, which must include both your checking and savings accounts. Total Family Members: Number of Dependants: Orutsararmiut Native Council PO Box 927 Bethel, Alaska 99559 Phone (907) 543-2608 Fax (907) 543-2639 Page 1 of 9

ONC s grant will not cover all expenses related to your education. You may apply for additional funding through the following local organizations: VOCATIONAL ONLY VOCATIONAL / COLLEGE VOCATIONAL / COLLEGE Dept. of Labor & Work-Force Bethel Lions Club Veterans of Foreign Wars Development Scholarship Committee Continuing Ed. Scholarship 460 Ridgecrest Suite 112 P.O. Box 646 P.O. Box 942 P.O. Box 1607 Bethel, Alaska 99559 Bethel, Alaska 99559 Bethel, Alaska 99559 (907) 543-4300 Message (907) 543-2241 Message (907) 543-2210 Phone (907) 543-2099 Fax 1(800) 478-2210 Toll Free VOCATONAL / COLLEGE VOCATIONAL / COLLEGE VOCATIONAL / COLLEGE Calista Scholarship Fund Bethel Native Corporation Coastal Villages Regional Fund (CVRF) 301 Calista Court, Ste A. P.O. Box 719 Fall deadline June 1 st ; Spring November 1 st Anchorage, Alaska 99508 Bethel, Alaska 99559 Contact your CVRF rep or call (907) 279-5516 Phone (907) 543-2124 Phone 1 (888) 795-5151 Toll Free (907) 644-6376 Fax 1 (888) 770-2124 Toll Free Email: www.coastalvillages.org 1 (800) 277-5516 Toll Free Email: www.bnc-alaska.com Email: scholarships@calistacorp.com ONC s College Application Deadlines: June 30 th, for Fall January 30 th for Spring semester If you re receiving assistance through AVCP S Temporary Aid to Needy Family (TANF), you may also qualify from its Native Employment Works (NEW) program. Call 543-7324 for more information. For additional funding, Alaska Student Loans are also available. The applications are at your closest Alaska Legislative Information Office (LIO). Please contact Kathy Hanson at Yuut Elitnaurviat at (907) 543-0951 if you are interested in Adult Basic Education (ABE) services (GED). Please note that ABE Center is closed during the summer months. Please contact me if you have any questions or need help completing any of the forms. Do well. Be good. Sincerely, Orutsararmiut Native Council Zack Brink, Executive Director Forrest Jenkins Charlotte Myers Danielle Stanley 477 Programs Director 477 Specialist 477 Specialist Email: fjenkins@nativecouncil.org Email: cmyers@nativecouncil.org Email: dstanley@nativecouncil.org Page 2 of 9

102-477 Programs Section I - APPLICANT INFORMATION Case Number: Name: Date of Birth: / / Social Security# - - Mailing Address: Physical Address: P.O. Box or Street Address City State Zip Street Address City State Zip Home Phone #: Message Phone#: Work Phone#: Sex: Male Female Marital Status: Single Married Separated Divorced Widowed Are you a Veteran? No If no, Selective Service Registration Number: Date Verified: N/A Yes If yes, dates: From: to Discharge Date: / / Branch: Ethnic Background: Alaska Native of American Indian / Native Hawaiian Hispanic African American Caucasian Other: Referred By: Self / Walk-in Social Services Vocational Rehab Other: Section II - APPLICANT DATA Household: List all household members including yourself # NAME DATE OF BIRTH AGE RELATIONSHIP 1 2 3 4 5 6 Household Income: List all household members including yourself, that are working and receiving income # NAME DATE OF BIRTH AGE RELATIONSHIP 1 2 3 4 5 6 In case of an EMERGENCY, Contact: # NAME ADDRESS PHONE RELATIONSHIP 1 2 Page 3 of 9

EDUCATION Type of High School Attended: BIA Tribal Private Mission Public Where: Check One: High School Diploma Still Attending No Longer Attending GED Certificate of Attendance Education Completed: List any Vocational and/or Colleges you have attended: Name of School: Mo / Yr: / Type of Degree / Certificate: Name of School: Mo / Yr: / Type of Degree / Certificate: Name of School: Mo / Yr: / Type of Degree / Certificate: Have you ever received any of the following services: No Yes (If yes, check all that apply) BIA Childcare Job Corp Military Other ONC Vocational State Jobs Veterans Where, When & Type of Training: CURRENT INFORMATION (HIGHER EDUCATION / VOCATIONAL TRAINING STUDENTS Request for Calendar Year: to Major: Name of University / College or Training Institution Mailing Address City State Zip Code Phone Number Fax College Level: Freshman Sophomore Junior Senior Graduate Level Expected Degree: Certificate AA BA BS MA Expected Graduation Date: I plan to live: On Campus Off Campus With Family STATEMENT OF PURPOSE: I CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE THE RELEASE OF ANY INFORMATION NEEDED BY ONC IN ORDER TO COMPLETE MY SCHOLARSHIP APPLICATION PACKAGE. I CERTIFY THAT ANY FUNDING THAT I DO RECEIVE WILL GO SOLELY TOWARDS MY EDUCATIONAL EXPENSES. I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO PROVIDE ONC WITH AS OFFICIAL TRANSCRIPT AFTER EACH TERM THA I AM FUNDED. I WILL RECEIVE A GRADE POINT AVERAGE (GPA) OF 2.0 OR ABOVE AND MAINTAIN A MINIMUM OF 12 (TWELVE) CREDIT HOURS PER TERM. I UNDERSTAND THAT IF I FAIL TO MAINTAIN THE ABOVE MINIMUM STANDARDS, I WILL BE PLACED ON PROBATIONARY STATUS FOR THE NEXT TERM. IF, WHILE ON PROBATION, I STILL DO NOT MEET 2.0 GPA / 12 CREDIT MINIMUMM, I WILL NO LONGER BE ELIGIBLE FOR 477 FUNDING FROM ONC UNTIL I COMPLY WITH THE ACADEMICALLY REQUIRED STANDARDS. Signature of Student Date of Application Page 4 of 9

Labor Force Status: Please check your status and complete the information below. Employed Full-Time Part-Time Self-Employed Unemployed: Number of weeks Last Hourly Wage: $ Employer: Occupation: EMPLOYMENT HISTORY (ALL APPLICANTS) Has alcohol or drugs ever caused problems for you at work? Yes No Please list your employment history information in Chronological order (Last to First) below: From: To: Job Title: Employers Name: Address: Phone Number: Supervisor s Name: List your duties and responsibilities: Are you eligible for rehire? Yes No Reason for Leaving: ****************************************************************** From: To: Job Title: Employers Name: Address: Phone Number: Supervisor s Name: List your duties and responsibilities: Are you eligible for rehire? Yes No Reason for Leaving: ****************************************************************** From: To: Job Title: Employers Name: Address: Phone Number: Supervisor s Name: List your duties and responsibilities: Are you eligible for rehire? Yes No Reason for Leaving: ****************************************************************** Page 5 of 9

BARRIERS TO EDUCATION, TRAINING OR EMPLOYMENT Check all of the items below which apply to you: Single; Head of Household Not in Labor Force Limited English Proficiency Unemployed 15+ weeks Disabled Individual Underemployed / Low Income Offender Public Assistance (Food Stamps, GA, etc.) Reading Skills below 7 th grade level TANF Recipient Math Skills below 7 th grade level Pregnant / Parenting Teen Homeless Substance / Alcohol Abuse Lack Significant Work History Treatment / Counseling Have you ever been convicted of any crimes involving alcohol or drugs? Yes No If yes, when, please explain? Have you ever been convicted of a felony? Yes No If yes, when, please explain? Are you currently on probation or parole? Yes No Probation / Parole Officer: Phone #: Are you scheduled for any substance abuse treatment? If yes, when? EMPLOYMENT GOALS & INTERESTS Check any skills you may have: Accounting Mechanical Maintenance Clerical Painting Welding Cashier Food Service Carpentry Receptionist Other: What is your career goal? Do you prefer to work by yourself or with others? List and tools and/or office equipment you have used: Certification of Application I certify that the information provided is true to the best of my knowledge. I am aware that the information provided is subject to review and verification and that I may have to provide additional information. I authorize Orutsararmiut Native Council to share this information for the purpose of assisting me in obtaining assistance, training, education, or employment. Applicant Signature Date Parent or Guardian Signature Date Page 6 of 9

CLIENT AGREEMENT I understand and agree to the following conditions: Academic Requirements: Behavior: Students seeking vocational training are required to maintain acceptable academic standing. This is usually a grade point average of at least 2.0 or a C average. Fulltime enrollment for vocational training shall not be for less than six months, and shall not exceed 24 months, with the exception of registered nurses training, which will be allowed up to 36 months of training. Higher Education Students are required to maintain a minimum of 2.0 Grade Point Average (GPA) with no less than 12 credit hours per semester. Higher Education students will be enrolled full-time (12 semester credits), with the exception of summer sessions, which requires a minimum of 6 semester credits. Failure to maintain the required minimum requirements will result in academic probation for one quarter or semester. If academic standards are not met after being placed on probation, the student will not be eligible for a future scholarship grant until academic requirements are met. It is the student s responsibility to have grades submitted to ONC s Education Department upon completion of each quarter or semester. All students must maintain acceptable social conduct within the policies and rules of the institution they are attending. Failure to meet these requirements due to reasons within the trainee s control may result in termination of training benefits. Any such termination will require the repayment of the scholarship amount to ONC. Alcohol and Drug Free Policy: A student may be terminated from any ONC Education, Employment & Training Program if he/she abuses alcoholic beverages or possesses or consumes alcohol and/or illegal or non-prescription drugs which lead to student breaking policies and rules of ONC programs, the post-secondary institution, State of Alaska or U.S. Government. Printed Name Signature Date Orutsararmiut Native Council P.O. Box 927 Bethel, Alaska 99559 Phone (907) 543-2608 Fax (907) 543-2639 Page 7 of 9

117 Alex Hately Drive PO Box 927 Bethel, Alaska 99559 Phone: (907) 543-2608 Fax: (907) 543-2639 BETHEL RESIDENCY & TRIBAL AFFILIATION Printed Name: Maiden: Social Security Number: - - Are you a Bethel Native Corporation Shareholder or a Descendant of a Shareholder? Yes No Are you an ONC Tribal Member? Yes No If yes, please list your ONC Tribal Enrollment Number: I have been a resident of Bethel since: / / I certify that the information listed above is true and correct to the best of my knowledge. Signature Date Orutsararmiut Native Council P.O. Box 927 Bethel, Alaska 99559 Phone (907) 543-2608 Fax (907) 543-2639 Page 8 of 9

RELEASE OF INFORMATION Date: To Whom It May Concern: I,, authorize and request the release of any and all information necessary to verify or determine my eligibility for participation in programs offered by Orutsararmiut Native Council s General Assistance Program. Agencies which may be contracted, but are not limited to are: Employers, State of Alaska Division of Public Assistance, Unemployment Offices, Social Security Administration, Retirement Agencies, Banks, etc. Printed Name Signature Social Security Number A reproduction of this release is as valid as the original; to be used indefinitely for the present and all future income verifications. Orutsararmiut Native Council P.O. Box 927 Bethel, Alaska 99559 Phone (907) 543-2608 Fax (907) 543-2639 Page 9 of 9