HEAP Application - Tribal Portal

Email address that you check on a regular basis

Name (the name on your W9 form and enrollment verification must match)

First Name

Last Name

Name

Date of Birth

Contact Number

Tribal Enrollment #

Are you an employee of the PYT Casino, Tribe or neither?

Mailing Address

City

State

Zip

Which Tribal Community do you affiliate with

What school (College/University) will you be attending?

Will you be attending school away from your home state?

NoYes

Have you received HEAP funding in the past?

NoYes

If so, when (year and semester)

Expected Graduation Date

Who is your assigned EAS, advisor

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.

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.

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.)

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.

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

Relation to you

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.)

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.

Student E-Signature (please enter your full legal name)

If you were unable to upload your required documents, please email them directly to your assigned EAS or if you are unsure, please email them to heapapplication@pascuayaqui-nsn.gov . You may also submit the required documents in person or by postal mail.

W-9 (original signature required, attach pdf file only)

Higher Education Assistance Program Application

Name (the name on your W9 form and enrollment verification must match)

If you were unable to upload your required documents, please email them directly to your assigned EAS or if you are unsure, please email them to heapapplication@pascuayaqui-nsn.gov . You may also submit the required documents in person or by postal mail.

Pascua Yaqui tribal portal