<p> STUDENT ENROLLMENT APPLICATION FOR STUDENTS ENROLLED IN BUREAU-FUNDED SCHOOLS</p><p>BIA FORM 6248 OMB NO. 1076.122 EXPIRES 12/31/93 JANUARY 1988</p><p>NAME OF SCHOOL ______</p><p>DAY SCHOOL ( ) BOARDING SCHOOL ( )</p><p>1. Identification Social Security #: ______</p><p>Name of Student: ______Last First Middle</p><p>Address: P.O. Box ______Street ______</p><p>City: ______State ______Zip Code: ______</p><p>Miles from home to school: ______</p><p>Date of Birth: ______Verified by: ______Month Day Year</p><p>Place of Birth: ______Sex: Male ( ) Female ( )</p><p>Tribal Affiliation: ______Degree Indian: ______</p><p>Enrollment Number: ______Home Agency: ______</p><p>Religious Affiliation (Optional): ______Father: ______</p><p>Address: ______Mother: ______Address: ______Tribal Affiliation: ______Home Agency: ______Tribal Affiliation: ______Enrollment Number: ______Home Agency: ______Living: ( ) Deceased: ( ) Enrollment Number: ______Occupation: (Optional) ______Living: ( ) Deceased: ( ) Employer: ______Occupation: (Optional) ______Telephone: Home ______Employer: ______Work ______Telephone: Home ______Emergency Name & Phone: Work ______Emergency Name & Phone: ______Other: (Specify) ______Legal Guardian: ______Other: (Specify) ______Address: ______Other: (i.e. group home, etc): ______</p><p>Address: ______Tribal Affiliation: ______</p><p>Home Agency: ______Telephone: ______Enrollment Number: ______Student Lives With: ______Occupation: (Optional) ______Telephone: Home______Employer: ______Work ______Emergency Name & Phone:</p><p>______</p>