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What type of service do you need?

Employment Class Room Training Supportive Services
Job Readiness Post-Secondary Training Child Care Assistance
Employment Counseling   (anything past high school) Social Services
Evaluation/Skills Testing Basic Education/GED Transportation
Job Search Activities Tutorial Services Uniforms
Youth Employment Other:  Other: 
On-the-Job Training   Other:     Other:  
Work Experience   Other:     Other: 

Post-Secondary Training

If you are receiving assistance with post-secondary classroom training, full or part-time, complete this section.
Name and Address of School Expected Start Date  
  Expected Graduation Date  
Degree/Major  
Have you applied for financial aid?
Phone Number of School -- Number of credits per semester: 
Year:  Fresh    Soph    Junior    Senior    Grad    Post-Grad 
   
If you are only taking one class (Adult Education), fill in this section also:
Name of Class: 

I declare the information given by me on this form is true.  This information may be shared with the BIA, Tribe, State and educational institution.  I will contact the financial aid office of the institution and apply for financial aid.  I request the financial aid office notify the Tribe of my financial need and authorize funds awarded to me be mailed to the institution I attend.  I understand that I must furnish the Stockbridge-Munsee Education Office a copy of my official transcript at the end of each funding period.  I am responsible for the repayment of funds if I do not successfully complete the courses I receive funding for.  (See the Education, Employment and Training Handbook for more details.)  I understand that the grant of funds by the Education Department is a contract.  In exchange for the grant of funds, I have certain obligations I must meet.  If I do not meet these obligations, the Education Department may pursue me for the return of funds. 

       
Student Signature:    Date