Siletz news /, July 01, 2000, Page 11, Image 11

TRIBAL PROGRAM NEWS
Tribal Head Start Enrollment Application
Return this application to: Siletz Tribal Head Start, PO Box 549, Siletz, OR 97380.
For more information, call 1-800-922-1399, ext. 264, or 541-444-8264.
1. Child’s name:
Returning:
2. Child’s sex: M
(circle one)
Yes
No
3. Child’s date of birth:/
)
4. Does child have any condition that may be considered a disability or special need?
No
Yes
Explain:
(please attach verification)
5. Is child descendent/member of a federally recognized Indian tribe? Yes
Roll #:
Tribe:
No
.
HC'» '.''U
-
Craig Whitehead (I) and Delight Attebury
(above) and Lisa Brown (I) and Josh
Morrow (below) enjoy the Eagle
Feather Ceremony.
(Please attach verification)
6. Parent/Guardian name(s):
1.
2.
Street Address:
City:
ZIP code:
Mailing Address:
City:
ZIP code:
Telephone #s: Home:
Work:
Message:
7. A preference for enrollment can be given to families who face any of the following
conditions: single-parent household, parent separated or divorced, child is a victim of abuse
or neglect, or child suffers a non-disabling medical condition. If your family meets this
criteria and you would like to claim that preference, please list the qualifyinq
condition(s) here:
4
Siletz Cultural Day 1
Camp Opens
!
8. List all other household members by name:
1.
2.
3.
5.
6.
9. Financial statement (you must attach verification of these benefits). Check all
that apply:
Employed
Child Support
Social Security
Other, explain
Unemployment
TANF
Disability
Total gross monthly income $:
General Assistance
Veteran’s Benefits
College Grants/Scholarships
(please attach verification)
10. With my signature I certify that the above information is complete and accurate:
Signature:
For Office Use Only
Date:
Date Received:
Staff Initials:
Siletz Tribal Head Start is an equal opportunity program and open to all children regardless of
race, color, age, sex, handicap, or national origin. Any person who believes she/he has been
discriminated against should write to the Secretary of Agriculture, Washington, DC, 20250.
July 25-28, 2000 - Government Hill
Sponsored by Cultural Department,
Cultural Heritage and Charitable
Ad-Hoc Committees
I
Camp activities will include I
I basketweaving, shell necklace and I
I moccasin making, flintknapping, |
I storytelling, introduction to tribal |
| language, traditional salmon bake, |
| and more.
।
|
Programs are asked to help with |
| planning and funding. The next planning |
| meeting will be on July 10 at 11 a.m. in g
| the Cultural conference room. Overnight g
| camping is available for tribal members g
। who live outside of Siletz. However, you g
। must have a chaperone if you’re under g
gage 18, no exceptions. The artwork ■
g contest was awarded to Christel H.T. ■
। Lane at the last planning meeting.
.
।
Please submit registration forms !
। by July 14. Questions? Call Selene !
g Rilatos or Craig Whitehead at !
! 1 -800-922-1399. ext. 246 and 230.
!
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