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About Siletz news / (Siletz, OR) 199?-current | View Entire Issue (May 1, 2007)
TRIBAL PROGRAM NEWS Siletz Tribal Head Start Enrollment Application Siletz Tribal Head Start Letter to Applicants Dear Siletz Tribal Head Start Applicant, Thank you for your interest in the Siletz Tribal Head Start program. We are currently accepting applications for the Fall 2007 school year. Siletz Tribal Head Start has classrooms in Siletz, Salem, Springfield, and Portland. Please complete the attached enrollment application and return it as soon as possible. You will be notified during August 2007 if your child was accepted into the program or placed on our waiting list. Every effort is made to provide daily transportation for all children enrolled in our program. However, due to considerations such as distance, time, and appropriate practice, you could be asked to self-transport should it be neces sary to maintain a safe, efficient bus route. 1. 2. 3. 4. 5. Return this application to Siletz Tribal Head Start, P.O. Box 549. Siletz, OR 97380-0549. For more information, call 1-800-922-1399, ext. 1376, or 541-444-8376. (2007-2008 year) 1. Child’s Name:____ — ----- ------ ---------- 2. Child’s Sex: M F 3. Child’s Date of Birth:_/_/___ Returning Student: Yes No 4. Does your child have any condition that may be considered a disability or special need? No Yes Please explain:_ _ ________ (please attach verification) Please return the following documents with your completed application: 5. Is child member/descendant of a federally recognized Indian Tribe? No Yes Documentation of family income from all sources, which may consist of: Roll # a. Current payroll check stub(s) for one month; b. TANF award statement or copy of current check; c. Foster care award statement or copy of check, d. Annual income tax or W-2 statement(s); e. Self-employment or business statement; f. Social Security or SSI award statement; g. Unemployment benefit statement or copy of check. (Income verification is mandatory for all families.) If applicable, documentation of child’s enrollment or descendency in a federally recognized Indian Tribe, which may consist of: a. Copy of tribal I.D.; b. Certificate of Indian Blood (CIB); c. For descendency, copy of tribal ID, CIB, or other documentation that verifies enrollment of parent, grand parent, great-grandparent, etc. and birth records that show lineage back to child. (Indian preference cannot be given unless verified.) If applicable, documentation of child’s diagnosed disability, which may consist of: a. Copy of Individual Family Service Plan (IFSP); b. Letter or statement from qualifying agency stating your child meets this definition, c. Letter or note from physician or other qualified health provider. (Disabil ity preference cannot be given unless verified.) Copy of child’s immunization record. (Note: This is required before any child can attend class.) Completed health and physical exam summary, signed and dated by physi cian. (Note: This is required within 45 days after the child is enrolled.) For your application to be fully complete, all of the above items should be attached. If you have any questions, please feel tree to contact me by telephone at 1-800-922-1399, ext. 1376, or 541-444-8376. In Partnership with Children and Families, DeAnn Brown, Director Siletz Tribal Head Start I Walk Off Craving for Nicotine I “Withdrawal symptoms related to a long-term effect, they should be com I I smoking can be better handled with bined with anti-smoking techniques. When you exercise, your body I walking,” says a research finding pub I lished in the medical journal Addiction. produces the natural dopamine, Researchers found that moderate which is responsible for mood en I I exercise certainly had a better effect hancement that reduces the smoker's craving for nicotine. Tobacco I on people who are making efforts to manufacturers put nico I quit smoking. They also are tine in cigarettes/chew at I of the opinion that if the higher and higher rates to I same effect were found in please the dopamine cen I a drug, it immediately ters in the brain. This in turn I would have been mar causes the addiction. I keted as an effective tool Why put all the chem I to give up smoking. icals and poisons in your body The most effective ex I when you can do it naturally with I ercises could be done outside a gym, out the side effects of smoking or walking, or isometric exercises, I like and tensing muscles. It was chewing? I Hexing For questions or help quitting, that a minimum of five minutes I found contact De Anna Pearl. Tobacco Pre of exercising was sufficient for smok I ers to keep their craving for a ciga vention and Education Program, at I rette under control. 541-444-9659 or 1-800-648-0449, I These exercises could come in ext. 1659; or the Oregon Quit Line I handy for a shorter bout of craving. For at 1-877-270-7867. I 12 • Siletz News • May 2007 Tribe(s):(please attach verification) 6. Parent/Guardian Name(s): j SSN:____ I__ I_____ 2 SSN:____ I___I_____ Street Address:_________________________________________________________ City: State:______________ ZIP Code:-------------------- Mailing Address:_—------------------------------------- City: State:ZIP Code:-------------------- Telephone: Home:Work:----------------— Message.------ -------------- 7. Bus pick-up and drop-off address if different from above: 8. A preference for enrollment can be given to families that face any of the following conditions: single-parent household, parents separated or divorced, child is a victim of abuse or neglect, or child suffers from a non-handicapping medical condition. If your family meets this criteria and you would like to claim that preference, please fist the conditions here: 9. List all other household members by name: Total # of household members----- 3._______________________________ 4------------------------------------------------- 5._______________________________ 6.------------------------------------------------ 10. Financial Statement (you must attach verification of these benefits). Check all that apply: Employed __ Unemployment _TANF Social Security College Grants/Scholarships General Assistance Veteran’s Benefits Child Support ---- Disability ___ Other, explain------------------------------ Total Gross Monthly Income: $ (you must attach verification) 11. With my signature I certify that the above information is accurate: S i g n at u re :—---------- Date: ----------------------- Siletz Tribal Head Start is an equal opportunity program and open to all children regardless of race, 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.
