Pueblo of Nambe Higher Education Scholarship

PUEBLO OF NAMBE EDUCATION DEPARTMENT Pueblo of Nambe Higher Education Scholarship 15A NP 102 West, Santa Fe, NM 87506 Phone: (505)455-4426 ~ Fax: (505)455-2038

The Pueblo of Nambe Higher Education Scholarship is federal funding administered by the Pueblo of Nambe Education Department. Students applying for this scholarship must be a tribal-enrolled member of the Pueblo of Nambe. Students must also be enrolled in a Post-secondary program.

FIRST TIME APPLICANTS: o Application o Tribal Enrollment Verification (proof of Nambe Pueblo tribal enrollment) o Agreement Letter o Privacy Statement o Proof of High School Diploma/GED Certificate o FAFSA (proof of submission on-line) (www.fafsa.gov) o Class Schedule (for the applicant term)

RE-NEWING APPLICANTS:

o Class Schedule (for the applicant term.) o End of Semester Grades (Name/student ID must be on final grades)

Deadline for first time application and class schedule there after:

FALL: The last Friday in August SPRING: The last Friday in January SUMMER: The last Friday in May

Any questions can be referred to: PUEBLO OF NAMBE EDUCATION DEPARTMENT 15A NP 102 West, Santa Fe, NM 87506 (505) 455-4426 work / (505) 455-2038 fax [email protected] Pueblo of Nambe Education Department Pueblo of Nambe Higher Education Scholarship 15A NP 102 West, Santa Fe, NM 87506 Phone: (505)455-4426 Fax: (505)455-2038

APPLICATION

Student’s Name: ______Student ID #:______

Social Security #: __XXX-XX- ______Email Address: ______

Permanent Address:______Street or P.O. Box City State ZIP Contact Phone: ______Alternate Phone: ______

Male:□ Female:□ Birth Date: ___/___/___ Single:□ Married:□ #Dependents: _____

High School Graduated From/GED: ______Date:______

Post-Secondary Institute: ______City State Major: ______Minor: ______Technical Trade: ______

Parent’s Signature (if student is under 18): ______

Student’s Signature: ______Date:______

DEADLINE DATE: FALL: The last Friday in August SPRING: The last Friday in January SUMMER: The last Friday in May Pueblo of Nambe Education Department Pueblo of Nambe Higher Education Scholarship 15A NP 102 West, Santa Fe, NM 87506 Phone: (505)455-4426 Fax: (505)455-2038

STATEMENT OF PRIVACY The Privacy Act of 1974 requires each Federal Agency that maintains a system of information on individuals to inform those individuals as to: a. the authority which authorizes the solicitation of the information and whether disclosure of such information is mandatory or voluntary; b. the principal purpose or purposes for which the information is intended to be used; and c. the routine uses which may be made of the information.

The Bureau of Indian Affairs Higher Education Assistance Program 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 32, Administration of Education 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 required of applicants. This form solicits the required information. Personal data will be made available to authorized users upon request. The applicant should understand that the intent in collecting and maintaining this data on individuals is to determine 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 make the applicant ineligible to receive higher education assistance under this program.

APPLICATION CERTIFICATION I certify that the information in this application is true and complete to the best of my knowledge. I am aware that any misrepresentation on this application will be grounds for dismissal from the program and/or for prosecution under federal law. By signing this application I authorize the Education Institution I am currently attending to release grades, attendance, financial aid, and any other information to the Pueblo of Nambe Higher Education Program. The disclosure of the above requested information by the applicant is voluntary but required to obtain benefits. Failure to provide requested information may result in delay of funds.

I have read this Statement of Privacy. I hereby provide the required information and authorize the use of such information to the extent of the uses specified in this statement.

Applicant's Signature Date PUEBLO OF NAMBE HIGHER EDUCATION SCHOLARSHIP AGREEMENT LETTER

This contract between the student (GRANT RECIPIENT) and the Pueblo of Nambe Higher Education Program (NP-HE), is made and entered into for the duration of GRANT RECIPIENT post-secondary career.

1. Upon the GRANT RECIPIENT acceptance of the scholarship, the awarded funds shall be used for educational expenses; any other use shall warrant repayment of the awarded funds. Awarded funds will be disbursed in this order half when class schedule is given to NP-HE and the second half when end of term grades are submitted to NP-HE.

2. The GRANT RECIPIENT shall be enrolled in an accredited post-secondary institution, pursuing an Associate degree, Baccalaureate degree, Graduate, or Undergraduate degree or trade certificate and shall maintain a minimum of a letter grade of “C” in each class and complete the required credit hours for full/part-time status as applies to the institution and program attending.

3. If GRANT RECIPIENT does not meet the “C” in each class they will not receive second payment. Subsequently they will not receive first payment for following semester, but can receive second payment if grades are met.

4. Withdrawal: The GRANT RECIPIENT shall attend the institution specified in their application and shall notify the NP-HE office in writing within ten (10) business days of withdrawing. Failure to do so will result in the following: cancellation of any future financial assistance from the NP-HE program. The GRANT RECIPIENT shall be required to repay the funds awarded.

5. Continued Funding: To be considered for continued funding, the GRANT RECIPIENT shall submit to NP-HE class schedule by the deadline date and end of term grades.

6. The GRANT RECIPIENT will notify NP-HE of the following: change in email address, change in Post-secondary Institute, and change in course of study.

7. Within 60 days after graduation, the GRANT RECIPIENT will notify the Nambe Pueblo Higher Education Program of his/her graduation date, degree conferred and major.

I, GRANT RECIPIENT, understand it is my responsibility to provide all required documents to the Nambe Pueblo Higher Education Office. I shall accept and abide by the conditions stipulated in the terms above and will be bound by the responsibilities and consequences thereof. Breach of any condition stated above may result in forfeiture of any current and/or future financial assistance from NP-HE.

GRANT RECIPIENT Signature GRANT RECIPIENT Print Name & Date