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
o
o
o
o
o
o
Application
Tribal Enrollment Verification (proof of Nambe Pueblo tribal enrollment)
Agreement Letter
Privacy Statement
Proof of High School Diploma/GED Certificate
FAFSA (proof of submission on-line) (www.fafsa.gov)
Class Schedule (for the applicant term)
RE-NEWING APPLICANTS:
o
o
Class Schedule (for the applicant term.)
End of Semester Grades (Name/student ID must be on final grades)
Deadline for first time application and class schedule there after:
FALL:
SPRING:
SUMMER:
The last Friday in August
The last Friday in January
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
Contact Phone: ___________________
Male:
□
Female:
□
City
State
ZIP
Alternate Phone: ___________________
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: _________________________________
DEADLINE DATE:
Date:_______________
FALL: The last Friday in August
SPRING: The last Friday in January
SUMMER: The last Friday in May
OFFICIAL USE ONLY
____________________________________________
Pueblo of Nambe Education Department
____________________
Date Received
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.
b.
c.
the authority which authorizes the solicitation of the information and whether disclosure of
such information is mandatory or voluntary;
the principal purpose or purposes for which the information is intended to be used; and
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