Application Student Application Form Step 1 of 4 25% Tribal Roll NumberName First M.I. Last GenderMaleFemaleDate of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AgeAddress Parish Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email PhoneBest Contact Time Current Grade LevelK1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeCurrent SchoolSchool ID #For High School Students OnlyDiploma PlanACT Composite ScoreTest Date Date Format: MM slash DD slash YYYY SAT ScoreTest Date Date Format: MM slash DD slash YYYY PSAT ScoreTest Date Date Format: MM slash DD slash YYYY Expected High School Graduation:202120222023202420252026202720282029Overal Grade Point Average (GPA)4.00 or above3.99–3.53.49–3.002.99–2.001.99 or lowerN/AGPA Scale4-point scale weighted4-point scale unweighted Educational GoalsGraduate / Professional Degree4-Year Program / Post-Secondary Education2-year Program / Post-Secondary EducationVocational-Technical Program / CertificateMilitaryWorkforceUndecidedCareer Interests Click the + icon to add more Hobbies / Extra-Curricular Activities Click the + icon to add moreEducational Supports of Interest Academic Readiness Academic Tutoring / Test Prep Student Advocacy College / Career Prep Life Skills SPED / Disability Resources Cultural Enrichment / Tunica Language Authorization I agreeI hereby grant permission for my child, if accepted, to participate in the Tunica-Biloxi Tribe EDUCATION DEPARTMENT. I also give my consent to their current school to make available to staff any and all information pertaining to my child’s educational progress in school. As a parent, I will fully support the goals of the program and help my son/daughter to support and attain these goals. I give the school my authorization to release this information to the program staff. As a participant, I understand that in order to receive resources and benefits such as Sylvan tutoring I must be registered and an active participant in the EDUCATION DEPARTMENT. We understand that all information contained in this application is for use only by the EDUCATION DEPARTMENT and will be kept confidential.