Adult Education Application

Below is a list of information you will need to provide when applying for assistance:

Higher Education:

Education Application
Copy of Registered Classes (showing Units being taken)
Acceptance Letter if available
Continued Education…last semester grades with new semester schedule

Vocational Training:

Education Application
Brochure/info from Vocational College
Copy of registered classes with length of program ü Any information regarding your course/costs

Direct Employment Assistance:

Education Application
Attach a statement regarding “why you are in dire need of this assistance, materials, tools, clothing, etc… and how it will be beneficial to you ü Letter from employer with date of hire, rate of pay, and hours worked per week; if uniforms or supplies/equipment/tools are required this needs to be on the letter as well.
Supply quotes, documents, invoices, documentation regarding your requests with a breakdown of Vendor Location, Quantity, and Cost per item, Calculate Total.

Please Fill out Form Below

What Type of Assistance are you applying for? ( Choose One ) *

Higher Education
Vocational Training
Direct Employment

Have you applied for Education Assistance within the last year / if so what type of assistance did you receive?

Name *

First

Middle

Last

Date

Phone

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Education ( Check One ) *

H.S. Diploma
GED
Highest Grade Completed ( Please add later )

School you wish to attend:

Type of training desired and/or Major Desired

Direct Employment:

Job Name:

Date

Hours worked per Wk:

Letter from Employer: File Upload

Click or drag a file to this area to upload.

Family Backround

Your Tribe: *

Roll number: *

Mother Name/Tribe: *

Father Name/ Tribe: *

Signature

Date

TO BE INITIALIZED BY APPLICANT FOR ADULT EDUCATION SERVICES ONLY:

I hereby apply to attend the school/Employment indicated on this application and agree to follow all rules, regulations and attendance requirements of the school/Employment. I further agree the funds issued for me for Education/Direct Employment purposes by the Stewarts Point Rancheria will be so used or repayment will be made to the Stewarts Point Rancheria. I further understand if I voluntarily quit employment within 6 months/School or fail due to attendance or behavior, I will be required to repay Stewarts Point Rancheria for not completing my Educational/Employment responsibilities. Stewarts Point reserves the right to deduct monies owed from quarterly distribution funds and be suspended from Educational Services for one year.

Signature

STEWARTS POINT RANCHERIA PRIVACY ACT:

1. Disclosure of the requested information by the applicant is voluntary, but required to obtain benefit. 2. The purpose of this information collection is to determine your eligibility for services. 3. The routine use of this information is by Stewarts Point Rancheria Staff to evaluate your request. The application will be used in a routine manner by Stewarts Point Rancheria staff working with you and school agencies or employers for information directly related to your request. 1. Failure to provide requested information may result in a delay or denial in receiving training or job placement assistance you are seeking.

Signature ( Privacy Act )

Date