Skip To Main Content

Logo Image

Logo Title

504 Form Instructions

Sample 506 Form

Everything on the form must be completed accurately by a parent or guardian. A district employee may not fill out missing information or make any corrections.

  • The student must be an enrolled member of a tribe, the child of an enrolled member, or the grandchild of an enrolled member to qualify. Great-grandchildren or further generations do not qualify.
  • The tribe must be a federally- or state-recognized American Indian or Alaska Native tribe. This includes federally- and state-recognized tribes or bands that have been terminated since 1940.
  • Please make sure you have the correct date of birth, school name, and grade level.
  • Name of Tribe, Band, or Group must be filled in.
  • Please check only one of the following: Federally Recognized, State Recognized, Terminated, or Organized Indian Group.
  • Name of individual with tribal membership (required)
    • If the person with membership is the student, write the student’s name.
    • If the person with the membership is the parent, write the parent’s name.
    • If the person with the membership is the grandparent, write the grandparent’s name.
    • Then check which individual with the membership is named.
    • Please do not write your child’s name down if your child is not currently enrolled.
  • Proof of membership or enrollment number (if readily available). Important! This is now required information to the best of your ability.
  • Please enter the tribal membership or enrollment number for the enrolled person.
    • If the student is enrolled, please write the student’s enrollment number.
    • If the parent is enrolled, please write the parent’s enrollment number.
    • If the grandparent is enrolled, please write the grandparent’s enrollment number.
    • OR Other (Explain): Please fill this section out if you do not have enrollment information.
    • If the person enrolled is deceased or estranged. Please do not guess if someone was enrolled; you must be sure.
    • If the child is adopted, specific information about enrollment is withheld for legal purposes.
    • If you or your child is enrolled, but the enrollment information is currently lost and needs to be replaced.
  • The name and address of the organization maintaining membership are required. Please fill this out to the best of your ability. If you only know the name of the tribe, city, and state of the organization, please write this down.
  • You must sign and date! An unsigned form is considered invalid.
  • Please include your mailing address and telephone number.