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photo of MIT's great dome

Native Heritage Form


Please respond to the following questions that are applicable to you. 

Last Name*:
First Name*:
Date of Birth (mm/dd/yyyy)*:

* required

 

Tribal Affiliation(s):

Are you registered? Yes      No

 

Nearest BIA Office, Office of Hawaiian Affairs, Tribal Council, or Native Alaskan Tribal Office with which you are affiliated:

 

Please describe the ties you have maintained (if any) to your reservations, Hawaiian/Alaskan homelands, or any other organizations or community groups.  If you have the name and contact information for such groups, please provide it here:

 

Does your school have an advisor who specifically works with Native students?  If so, please provide his/her name and contact information here:

 

If you have any other comments or information regarding your native heritage, you may include it here: