Graduate Stipend Application

Please Note:

Applications must be renewed each academic year. Applications are open from May 1st, 2025 through June 30th, 2025.
Funds are awarded on a first come, first served basis annually.
Katy Holland, Education Specialist, is the contact person for this stipend.
Students are responsible for updating any changes in contact information during the school year.
THIS APPLICATION IS FOR GRADUATE STUDENTS ONLY

This stipend is for graduate students enrolled in the Siletz Tribe. Applications are open May 1st, 2025 through June 30th, 2025. Please read the application carefully and submit all the documentation required. Incomplete applications will not be accepted.

"*" indicates required fields

Step 1 of 3

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The submission period for applications and all supporting documentation is May 1st, 2025 through June 30th, 2025. Funds are awarded on a first come, first served basis annually. In addition to the completed application form, the following documentation must be submitted in order for your application to be complete and eligible for funding:

A personal letter in which you state why you require a graduate stipend, how you plan to use the funding, and describe your plans and goals after graduation.
A copy of your undergraduate degree(first-time applicants)
A letter of acceptance from the college you plan to attend (first-time/transferring applicants only).
Proof that you've applied to the Oregon Tribal Student Grant (if attending an Oregon-based school)

Personal Information

Name*

First Middle Last

Previous Last Names Used (if any)

Contact Information

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Is your physical address different than your mailing address?*

Yes

Physical Address*

Street Address Address Line 2 City State ZIP Code

County of Residence*

Home Phone

Work Phone

Cell Phone

Preferred Email*

(Most Frequently Checked)

Message Number

Message Contact

Personal Information

Date of Birth*

Number of Dependents

Veteran?*

Yes

Siletz Tribal Member?*

Yes

CTSI Roll Number*

Graduate School Information:

College/University Information

Name of College/University

Location of College/University

Degree Earned

Date Graduated

Use the plus button to the right to add another college/university.

Under-Graduate School Information

Application Request Year*

For the Following Term(s)*

Academic Year

Fall Only

Winter Only

Spring Only

Will Be Attending*

Full-time

Part-time

3/4-time

Name of College or University*

Year in Degree Program*

Address of College or University*

Student ID Number (if assigned)

Department*

Expected Date of Graduation*

Expected Degree*

MA/MS

PhD

MSW

JD/MD

Other

Have you ever previously received a Graduate stipend?*

Yes

If yes:*

School Attended

Terms Attended

Semesters Attended

Total Credit Hours

Use the plus button to the right to add another school.

Current Status in Education Program*

Good Standing

Probation

Suspended

Statement of Education Purpose*

I declare that any funds received from the Confederated Tribes of Siletz Indians of Oregon (CTSI) Higher Education Program will be used solely for expenses connected with attendance at:

Name of Institution:*

Privacy Act and Paperwork Reduction Act Statement

This information is provided pursuant to public law 93-579 (Privacy Act of 1974), December 31, 1974. Although furnishing personal information to this office is voluntary, failure to supply complete and accurate information may preclude the applicant for eligibility for assistance under this program.

This information is being collected to determine eligibility of individuals applying for services. This information will be used to produce statistical records required of the Office of Indian Education Programs. Response to this request is required to obtain a benefit.

I hereby certify that the above information provided on this form is true and correct to the best of my knowledge.

Signature*

Date*

MM slash DD slash YYYY

Release of Information

Name*

First Last

Student ID Number

Date of Birth*

To whom it may concern:*

By checking this box, I do hereby authorize the release of any and all information regarding my case file as it relates to the eligibility/application for assistance from the Confederated Tribes of Siletz Indians (CTSI), for the Academic Year listed on this application under "College Information".

This authorization includes but is not limited to the following:

Grade Reports, transcripts and progress reports

Attendance verification

Financial aid transcripts and budget summaries

Personal reports, program participation and/or requirements

I permit the information to be released to the Confederated Tribes of Siletz Indians (CTSI) Education Department.

Signature*

Date*

MM slash DD slash YYYY

I authorize the Confederated Tribes of Siletz Indians to release information from my education file to my school or other programs that I am participating in.

Signature*

Date*

MM slash DD slash YYYY

I consent to having my name and/or picture placed in the Siletz News and local tribal newsletters for any educational accomplishments that I may achieve.

Signature

Date

MM slash DD slash YYYY

Personal Letter*

State why you require a higher education grant, how you plan to use the funding, and describe your plans and goals after graduation.

Save a copy of your letter for your records before submitting this application.

Upload Documentation - Copy of your undergraduate degree*

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 10 MB, Max. files: 8.

Upload Documentation - Letter of Acceptance for Admission

For first-time students or students who are transferring)

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 10 MB, Max. files: 8.

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Name

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Graduate Stipend Application

Please Note: