Student School And Activity Fund Application - Union Public Schools, Form W-9 - Request For Taxpayer Identification Number And Certification

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Choctaw Nation of Oklahoma
Student School and Activity Fund Program
POB 1210
Durant, Oklahoma 74702
800-522-6170
580-924-8280
Thank you for your interest in the Choctaw Nation’s Student School and Activity Fund Program.
We are pleased to send this application for financial assistance. Students must be Choctaw and
a tribal member of the Choctaw Nation of Oklahoma. Students who are attending Head Start
through High School are eligible to apply for the $100.00 donation one time each funding cycle.
The FY12 funding cycle will begin October 3, 2011 and will end August 1, 2012. Incomplete
applications are logged in and discarded. Due to the tremendous number of applicants and
telephone calls, we are unable to contact you regarding your application. Home school parents
please call for instructions.
PLEASE READ AND FOLLOW THESE DIRECTIONS!
USE BLACK OR BLUE INK
Fully complete all 10 places of Section 1.
Fully complete Section 2 OR
Section 3.
Copy your child’s Choctaw tribal membership and social security card on
one sheet of paper. Please do not send a copy of the child’s CDIB card.
If you send more than one application, please do not send all of your
children’s cards on the same sheet. This delays processing!
Complete the W9 Form. It is required. All information should be
completed with the child’s information only. Please use only your mailing
address on the application and the W9 form. The W9 form is used to put
your child’s information in our computer system and is not used for tax
purposes. The W9 form also tells us where to mail your child’s check.
Incomplete applications are logged in and discarded. Applicants must re-
submit a fully completed application in order to be funded.
We do not contact applicants for any purpose.
• No Faxes. MAIL your original application, copies of student’s cards, and W9 form.
• Students who graduate from high school cannot apply after their graduation date.
• Absolute Application Deadline is
on or before
August 1, 2012. Fully completed
applications must be in our office no later than 4:30 pm on this day. We do not
recognize postmark dates!
• “First-time Students” beginning school (Pre-K/Head Start) in August or September, 2012
are eligible to apply in the new funding cycle which begins on October 1, 2012.

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