DISBURSEMENT APPLICATION

BIA GRANT APPLICATION PACKET

Please read each of the following two (2) documents carefully


THEN fill out the form below. All required information must be submitted. No funds are available for release until this application and all the required documents have been received by this office.

Tribe Name:      Tribal ID: 
    Your First Name:      Your Last Name: 
    Your Address:      Your City: 
    State:      Zip Code: 
    Your Phone#:      College Name: 
    College Address:      College City: 
    College State:      College Zip: 
    College Fin. Aid Phone#:    Current Eduacational Goal: 
    Semester/Quarter Units:      Units Needed to Graduate: 
    Expected Date of Grad.:      Course of Study: 
    Major:      Minor: 
  Check will be sent to:      Your Email (optional): 


Call us at (707) 472-2100
We are located at:
3000 Shanel Road, Hopland, Ca. 95449
Open 8:30am - 5pm Monday - Friday

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