UNIVERSITY, COLLEGE, AND VOCATIONAL SCHOOLS

PECHANGA SCHOLARSHIP PROGRAM

Temecula Band of Luise?o Mission Indians Post Office Box 1477 ? Temecula, CA 92593

Telephone (951) 770-6136 Fax (951) 676-2731

UNIVERSITY, COLLEGE, AND VOCATIONAL SCHOOLS

In order to be considered for Tuition Assistance, please submit the following information to the Pechanga Scholarship office. Incomplete applications will not be processed.

CHECKLIST

Completed Application

Completed Educational and Career Goals Statement

All Signatures (FERPA, Graduation Requirement, GWA policy)

Copy of Pechanga Indian Reservation Tribal ID card

PLEASE NOTE:

? Payments are made on a quarterly/semester basis. Please notify this office two weeks prior to a payment being due each term.

Payments are NOT automatic.

?

Reimbursements requests for tuition, books, or fees must be received within 30 calendar days of payment.

?

New applications must be submitted each year prior to the Fall term. ? You can verify school accreditation through the U.S. Department of Education Database of

Accredited Postsecondary Institutions and Programs.

PECHANGA SCHOLARSHIP PROGRAM

Temecula Band of Luise?o Mission Indians Post Office Box 1477 ? Temecula, CA 92593

Telephone (951) 770-6136 Fax (951) 676-2731

UNIVERSITY, COLLEGE, AND VOCATIONAL SCHOOLS

STUDENT INFORMATION: Name: _________________________________________________________________________________ Today's Date: ________________ Date of Birth: ____________________________

Enrollment No: ___________________ (Office Use: MIP#___________________________) Address: ____________________________________________ City: _________________________ State: _________ Zip:______________ Mailing Address (if different from above) __________________________________________________________________________ Home Phone Number: ___________________________________ Cell Phone Number: _____________________________________ Email: __________________________________________________________________

Student ID #_________________________________

SCHOOL INFORMATION: School Name: _________________________________________________________________ Phone: ________________________________ School Address: _________________________________________ City: _____________________ State: ________ Zip: _____________ Career Objective: ____________________________________________ Major: _________________________________________________ School Website:_____________________________________________ Is the School Accredited? (Y/N) _____________________

This school year I plan on attending: _____Fall ____Winter ____Spring ____Summer (check all that apply)

Start date (this school year): ______________________________

Current Class Status: ________________________________(freshman, sophomore, junior, senior, fifth year, graduate) Expected Graduation Date:

_______________________

SURVEY QUESTIONS: Have you ever received a Pechanga Scholarship as an adult? (Y/N) _____________________________________________ Did you receive a high school diploma or GED? ___________________________________________________________________ Would you be willing to work in one of the Pechanga's Tribal Enterprises? ____________________________________ Which ones are you interested in? __________________________________________________________________________________ When would you be able to work: while in school, during summer break, after graduation?

List all that apply. __________________________________________________________________________________________________________________

For Office Use Only: DEGREE

TRACKER

Type:____________________

Units Completed: ________ Units Repaid: _________ Units Needed: ________ Class YR: ________

PECHANGA SCHOLARSHIP PROGRAM

Temecula Band of Luise?o Mission Indians

Post Office Box 1477 ? Temecula, CA 92593 Telephone (951) 770-6136 Fax (951) 676-2731

INFORMATION RELEASE FORM (FERPA)

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. ? 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.

In accordance with FERPA, it is a policy to withhold certain educational records unless the student provides consent to disclose information. The purpose of this form is to provide the consent to my school as required by FERPA.

I, the undersigned, hereby authorize my school to release/discuss the specified educational records and information:

Educational Records and Information:

? Review of all Educational Records including: ? Financial Aid Information ? Enrollment Verification ? Billing, Payments, Student Accounts Records ? Program Completion

Please exclude the following information___________________________________________________

Send Records to: Pechanga Indian Reservation Education Support/Scholarships Joann Kudell/Elyssia Perez/ Nicole Macarro P.O. BOX 1477 Temecula, CA 92593 Phone: 951-770-6136 Fax: 951-676-4338 Email: jkudell@pechanga-

This release does not permit the disclosure of these records to any other persons or entities without my written consent or as permitted by law. This release form is effective until December 31, 2017

________________________________________________________ _________________________________________ _____________________

Student Signature

Student ID number

Date

Information may also be accessed electronically through my electronic student information system with the information below.

________________________________________________________________________________________________________________

Online Education Information Web Address

Username

Password

PECHANGA SCHOLARSHIP PROGRAM

Temecula Band of Luise?o Mission Indians

Post Office Box 1477 ? Temecula, CA 92593 Telephone (951) 770-6136 Fax (951) 676-2731

NEW GRADUATION REQUIREMENT: If a tribal member receiving a scholarship withdraws from the school

prior to graduation, the tribal member shall repay any assistance provided through the garnishment of his or her

per capita distribution.

X_______________________________________________________________________________________________________________

Tribal Member Signature

Enrollment #

Date

GENERAL WELFARE ASSISTANCE: I have read and understand the general welfare assistance guidelines.

(Please keep the attached guidelines for your records). I understand that I must satisfactorily complete all

coursework paid by Pechanga to avoid garnishment of my per capita distributions.

X_______________________________________________________________________________________________________________

Tribal Member Signature

Enrollment #

Date

Educational and Career Goals:

_______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________

PECHANGA BAND OF LUISE?O INDIANS GENERAL WELFARE ASSISTANCE

ADULT SCHOLARSHIP ASSISTANCE PROGRAM GUIDELINES

Section 1.0 General Provisions

1.1 Authority. The Internal Revenue Code Section 139E recognizes the sovereign right of tribal governments to provide general welfare benefits to tribal members under certain circumstances on a non-taxable basis. On December 14, 2014, the Pechanga Band of Luise?o Indians ("Band") approved the General Welfare Assistance Ordinance ("Ordinance") to provide for the administration of general welfare benefits to eligible tribal members on a non-taxable basis. The Adult Scholarship Assistance Program, described herein, is authorized pursuant to the Ordinance.

1.2 Program Assistance Is Non-Taxable. Any general welfare assistance provided to tribal members pursuant to the Adult Scholarship Assistance Program is excluded from tribal members' gross income.

1.3 Program Assistance Creates No Vested Right. Any general welfare assistance provided to a tribal member pursuant to the Adult Scholarship Assistance Program shall not be treated as a vested right of the tribal member for any purpose.

1.4 Program Funding. All general welfare assistance provided pursuant to the Adult Scholarship Assistance Program is subject to the availability of budgeted Tribal Government funds and there is no guarantee that such funds will be available.

1.5 Minimum Program Requirements. The Adult Scholarship Assistance Program shall adhere to the minimum requirements set forth in Section 501 of the Ordinance.

Section 2.0 Program Description

2.1 Background. As a result of generations of historic trauma, failed government programs and the lack of adequate federal, state and local government educational programs and services to Native Americans, the Band's tribal community experiences chronic education issues. This includes high rates of truancy, high school dropouts, failures to achieve a high school diploma, and a dearth of tribal members attending higher education institutions and vocational facilities. To combat these growing problems, the Band authorized various education-related assistance programs, including the Adult Scholarship Assistance Program, described herein.

2.2 Purpose. The purpose of the Adult Scholarship Assistance Program is to promote the achievement of higher education by tribal members by providing tuition assistance for attendance at qualified colleges, universities, and vocational programs located within the United

General Welfare Assistance Adult Scholarship Assistance Program

November 2015 Page 1 of 4

States. The Adult Scholarship Assistance Program ensures that tribal members can attend higher quality educational facilities in order to improve their quality of life, serve the tribal community, and provide for their families. Providing quality higher education and vocational training opportunities to the tribal members strengthens the general welfare of tribal members, and the tribal community as a whole, because well-educated tribal members are better able to serve and advance the circumstances of our entire tribal community. Supporting the education and training of tribal members of ensures the Band's viability for the future.

2.3 Funding Uses. All assistance provided pursuant to the Adult Scholarship Assistance Program shall be used for the cost of tuition, mandatory fees, and books for an eligible tribal member to complete an eligible degree or program. Room and board assistance is available to tribal members completing such degrees and/or programs who do not receive per capita distributions.

Section 3.0 Program Guidelines

3.1 Adult Scholarship Assistance Program Representative. The Adult Scholarship Assistance Program Representative shall have the authority and responsibility to administer the Adult Scholarship Assistance Program under the oversight of Tribal Council.

3.2 Eligibility Requirements. All enrolled members of the Band are eligible to receive assistance under the Adult Scholarship Assistance Program, provided they meet the following criteria:

3.2.1 The tribal member has no more than one general welfare educational assistance award for which he/she is in active repayment due to forfeiture; and

3.2.2

The tribal member is currently enrolled in an accredited post-secondary education institution or program. A list of accredited post-secondary educational institutions and programs can be found through the U.S. Department of education website: .

3.3 Eligibility Certification. The Adult Scholarship Assistance Program Representative shall adopt procedures for certifying a tribal member's initial and continuing eligibility for assistance under the Adult Scholarship Assistance Program.

3.4 Recertification. A tribal member's eligibility to receive assistance pursuant to the Adult Scholarship Assistance Program must be recertified each school year.

3.5 Application Requirement. To receive assistance pursuant to the Adult Scholarship Assistance Program, eligible tribal members must submit a completed and signed Adult Scholarship Assistance Program application, accompanied by all the required documents, to the Adult Scholarship Assistance Program Representative prior to attending any classes and or vocational programs for which assistance is sought.

General Welfare Assistance Adult Scholarship Assistance Program

November 2015 Page 2 of 4

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