SPS Indian Education 506 Form

ED 506 Form- Indian Student Eligibility Certification Form for Title VI Indian Education Formula Grant Program
OMB Control No. 1810-0021
Parent/Guardian: This form serves as the official record of the eligibility determination for each individual child included in the student count for the Title VI Indian Education Formula Grant Program. If you choose to submit a form, your child could be counted for funding under the program. The grantee receives the grant funds based on the number of eligible forms counted during the established count period. You are not required to complete or submit this form unless you wish for your child(ren) to be included in the Indian student count.
This form should be kept on file with the grant applicant and will not need to be completed every year. Where applicable, the information contained in this form may be released with your prior written consent or the prior written consent of an eligible student (aged 18 or over), or if otherwise authorized by law, if doing so would be permissible under the Family Educational Rights and Privacy Act, 20 U.S.C. ยง1232g, and any applicable state or local confidentiality requirements.

Student Information


Tribal Membership

The individual with Tribal membership is the *
Name and address of Tribe or Band that maintains updated and accurate membership data for the individual listed above:
The Tribe or Band is *
Proof of membership in Tribe or Band listed above, as defined by Tribe or Band is: *


I verify that the information provided is true and correct to the best of my knowledge and belief.
Signature *