Jo
McDaniel
click here to
email (800) 522-6170
ext.2547
Chief
Gregory E. Pyle
Asst. Chief
Gary Batton
This comprehensive form is
the first step towards your brighter tomorrow. Gather all
necessary materials listed in the Form Checklist before
filling in the form. Once gathered, fill in all
requested information to the best of your ability. Contact
us if you have any questions or problems.
STEP
1: CHECKLIST
Students are
responsible to make sure all needed documentation requested
below has been received to be eligible
for assistance. Once this has been collected, complete
the form below to register for eligibility.
Application
Resume
Financial Aid Letter
High School Transcript
College Transcript:
Fall
Spring
Summer
Winter
ACT Scores
SAT Scores
Choctaw Tribal Membership
College Schedule:
Fall
Spring
Summer
Winter
Active
STEP 2: COMPLETE
THE FORM
Last Name
First Name
Middle
Maiden (if applicable)
Email Address
Confirm your e-mail
for accuracy:
Parents/Guardian Name:
Last
First
Middle
Parent/Guardian e-mail
Confirm Parent/Guardian email Address
CREATE
YOUR LOGIN
User Name:
Password:
Secret Question: Enter a question that you can answer easily. You will be
prompted to answer this question.
if you forget
your password. Not sure of the best way to set this up –
choice
of Questions – discuss w/ Database writer
Secret Question Answer:
PERSONAL
INFORMATION
Gender:
Male
Female
Date of Birth
(mm/dd/yyyy):
Social security Number:
PERMANENT
HOME ADDRESS
Street Address:
Apt # / PO Box:
City:
State or Province: List of US States & Canada Provinces
(drop down box displaying list as choices)
Zip/Postal
Code:
Primary Phone
Number: (please include area code)
ext.
Secondary Phone
Number: (please include area
code)
Current Education
Select your Classification:
Full or Part-Time Student:
Full-time Student
Part-time
Student
Intended or Current College Major:
Not Listed?
Intended or
Current College Second Major/Minor (if known)
Do your
future plans include attending summer school?
Yes
No
If yes, when?
If yes, which
college?
Do you have an internship?
Yes
No
If Yes – please list the following:
Name of Employer
Address
Contact Person at Employer
Phone number ext.
Email address
Do you receive payment for your internship? Yes
No
Are you interested in an Internship through the
SAP program? Yes
No
HIGH SCHOOL INFORMATION (All Applicants)
High
School Name:
City:
State
or Province: List
of US States & Provinces (drop down box displaying
list of states & provinces)
Graduation
Date (mm/yy):
Cumulative GPA:
Have you taken the ACT? Yes
No
If yes, what
was your cumulative score?
Have you taken
the SAT? Yes
No
If yes, what
was your cumulative score?
CURRENT
COLLEGE/UNIVERSITY INFORMATION (College
Applicants Only)
Name of College/University attending or plan to
attend:
Click here to choose your college/university (this is
a link to a list of choices)
Not Listed – need
to leave a blank
Cumulative
GPA: If you do not
yet have a college GPA, enter 0’s
and leave Term blank.
Are you set up by Tri-mesters? Yes
No
GPA Scale:
Projected College
Undergraduate Graduation Date (mm/yy):
Projected
2-Year/Community College Graduation Date (mm/yy):
Projected
4-Year College/University Graduation Date (mm/yy):
CURRENT
COLLEGE/UNIVERSITY MAILING ADDRESS
(College
Applicants Only)
Dormitory (If Applicable):
Address:
Street/PO Box:
City:
State or Province: List of US States & Provinces (drop
down box displaying list of states & provinces)
Zip / Postal Code:
Country:
Campus Telephone
Number: (please include area code) ext.
Contact Phone
Number of Parent / Guardian (please include
area code): ext.
Are you
taking out loans to pay for college?
Yes
No
Approximately how much do you presently owe?
CUSTOMER
INTERFACE INFORMATION
First Name
Last Name
Street Address:
Apt # / PO Box:
City:
State or Province: List of US States & Canada Provinces
(drop down box displaying list as choices)
Zip/Postal Code:
Primary Phone
Number: (please include area code)
ext.
Secondary Phone
Number: (please include area code)
