Johnson O’Malley Program Application

A parent/guardian must complete this application if they need support for their child in school such as but not limited to academic support, cultural actives, family engagement activities, and other family services or supports.

Eligibility Requirements:

Enrolled member of a federally recognized tribe or Alaskan Native or is a documented ¼
blood of Native American
Between the grade K through 12th
Living within the defined service delivery area (FNSBSD)

"*" indicates required fields

Step 1 of 2

STUDENT INFORMATION

Student Name*

Date of Birth*

Phone Number*

School*

Grade*

Does student have an IEP?*

Yes

Parent or Guardian's Name*

Parent or Guardian's Email*

Parent or Guardian's Address*

Street Address City State ZIP Code

Download Form

Johnson O’Malley Program Application

STUDENT INFORMATION

TRIBAL ENROLLMENT VERIFICATION FORM