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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