BACKGROUND INFORMATION
Last Name:   First Name:

Maiden Name (if applicable):

Home Phone:   Work Phone:

Fax:   Cell Phone:  

Mailing Address:

City:   State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

SSN:   E-mail:  

Date of Birth:   Gender: Male  Female

Tribal Affiliation: Tlingit   Haida   Tsimshian   Other

Are you a Sealaska Shareholder? Yes   No

If a lineal descendant, please enter the name of relative who is a shareholder:
Last Name:   First Name:

The relative's relation to you: Parent   Grandparent   Great-Grandparent
 

EDUCATION INFORMATION
Have you ever received a Sealaska Scholarship?  Yes   No

If yes, list years you received award(s):

Do you want your name and contact information to be added to a database to receive a scholarship application for the next academic year?  Yes   No

Name of college, university or vocational school(s) attended:

Choose One: Full-Time Student     Part-Time Student

Did you graduate or complete your training? Yes   No

If yes, what type of degree did you receive?
Choose One: Ph.D. Masters Degree Bachelors Degree Associates Degree Vocational Certificate in

If you are continuing your education, what type of degree are you pursuing?
Choose One: Ph.D. Masters Degree Bachelors Degree Associates Degree Vocational Certificate in
 

EMPLOYMENT INFORMATION
Sealaska Corporation and Sealaska Heritage Institute periodically have job openings for which you may qualify, or we are notified of job opportunities from other employers.  Would you like to be notified of such opportunities on a continual basis by e-mail?  Yes   No

Are you currently seeking employment?  Yes   No

If yes, what are your fields of interest (check one or more)?

If you are currently seeking employment, in what geographical areas are you willing to work?

Have you served on any nonprofit boards?  Yes    No

If yes, please list nonprofit board(s):

Have you served on any for-profit boards?  Yes    No

If yes, please list for-profit board(s):

Please list any skills in your field(s) of interest you would like potential employers to know about (you may forward a copy of your resume and references to us):

If already employed:
Name of Company/Employer:  

Your Title:

Mailing Address:

City:   State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

Annual Income:

Are you employed in the field in which you received your degree?
Yes   No

Are you self employed are do you own your own business? Yes   No

Briefly describe your involvement in or contributions to the Native Community since you received your SHI Scholarship or Heritage Study Grant: