MITW - Indian Grant

Personal Information

Enrollment Number: (ex: U00009999)

Academic Year:

Email Address:

Last Name:

Suffix:

First:

Middle:

Maiden:

Zip:

Mailing Address:

Social Security No.:

Date of Birth:

October 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
40	28	29	30	1	2	3	4
41	5	6	7	8	9	10	11
42	12	13	14	15	16	17	18
43	19	20	21	22	23	24	25
44	26	27	28	29	30	31	1
45	2	3	4	5	6	7	8

Gender:

Marital Status:

No. of Dependents:

Only numbers allowed.

Telephone/Cell:

Parental Information

Applicants Father's First and Last Name:

Tribe:

Applicants Mother's First and Maiden Name:

Tribe:

High School Information

Name of High School Attended:

If not listed:

Type:

High School or GED Completion Date:

October 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
40	28	29	30	1	2	3	4
41	5	6	7	8	9	10	11
42	12	13	14	15	16	17	18
43	19	20	21	22	23	24	25
44	26	27	28	29	30	31	1
45	2	3	4	5	6	7	8

College Information

College Academic Level:

Expected College Enrollment Status:

Housing:

Student Type:

College Type:

Name of College you plan to attend:

If College not listed:

Major/Program:

If Major not listed:

Degree:

Expected College Graduation Date:

October 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
40	28	29	30	1	2	3	4
41	5	6	7	8	9	10	11
42	12	13	14	15	16	17	18
43	19	20	21	22	23	24	25
44	26	27	28	29	30	31	1
45	2	3	4	5	6	7	8

Previous Colleges Attended:

Release of Information

STUDENT CONSENT & RELEASE OF INFORMATION:

I certify that the information given by me on this form is true, correct, and complete to the best of my knowledge.
I authorize the sharing of information on this form between MITW Education Office, the State and the college/university/school in order to complete my financial aid package.
I authorize the school's financial aid office to provide the Education Office with my financial need analysis.
I authorize the college/university/school to disclose my educational records to the Education Office.

Electronically Signed By:

Submit

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