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Pascua Yaqui Tribe
Pascua Yaqui Tribe
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This Application form will open November 1st 2023.
HEAP Application is closed!
Higher Education Assistance Program Application
Email address that you check on a regular basis
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Name (the name on your W9 form and enrollment verification must match)
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*
Date of Birth
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Contact Number
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Tribal Enrollment #
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Are you an employee of the PYT Casino, Tribe or neither?
PYT Casino
PYT Tribe
Neither
Mailing Address
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City
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State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
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Which Tribal Community do you affiliate with
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Barrio Libre
Coolidge
Guadalupe
Marana
New Pascua
Old Pascua
Penjamo
none of the above
What school (College/University) will you be attending?
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Will you be attending school away from your home state?
Will you be attending school away from your home state?
No
Will you be attending school away from your home state?
Yes
Have you received HEAP funding in the past?
Have you received HEAP funding in the past?
No
Have you received HEAP funding in the past?
Yes
If so, when (year and semester)
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Expected Graduation Date
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Who is your assigned EAS, advisor
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Cecilia Tavena
Olivia Valencia
Sabrina Alvarez
Unknown
I certify that the above information on this form is true and correct. If any of the information is falsified, I understand that this may disqualify me for Higher Education Assistance.
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I understand that any funding assistance awarded to me is to provide a portion of my educational costs to attend a post-secondary institution. Any assistance I receive will be mailed directly to the address I have listed on my W-9 form. I also acknowledge that it is my responsibility to inform the Higher Education Assistance Program, specifically, my assigned Education Assistance Specialist, of ANY and ALL address, telephone or email updates that need to be made to my Higher Education Assistance Program student file.
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I acknowledge that I have read and understand the Pascua Yaqui Higher Education Assistance Program Ordinance. I understand that it is my responsibility to comply with the Ordinance and the Higher Education internal policies to receive higher education assistance. I also understand that revisions to the Higher Education Assistance Program Ordinance may occur. (Revisions may replace, modify, or eliminate the existing ordinance.)
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Per the Higher Education Assistance Program Ordinance (Section 50, (a)), The Higher Education Assistance Program shall keep all applicant files confidential. In order for the Program to discuss information regarding an applicant, the applicant must submit a signed disclosure statement specifying the individual(s) and/or entities to receive the information.
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Therefore, I hereby give authorization to receive, submit any documents, and pick up (name of person, entity authorized by you) (relation to you) checks (if prior arrangements are made) or to inquire about my student file on my behalf
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Relation to you
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I also hereby give authorization to the Pascua Yaqui Tribe Higher Education Assistance Program to request and receive any and all information pertaining to my financial aid status and academic progress (this includes all registration, transcripts and financial aid documents.)
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I also understand that it is my responsibility to submit this form to the Pascua Yaqui Tribe Higher Education Assistance Program before the application deadline date. I understand that if I do not submit this application by the deadline date, my application will NOT be considered for funding.
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Student E-Signature (please enter your full legal name)
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W-9 (original signature required, attach pdf file only)
