USDA/1994 Tribal Scholars Program

OMB No.:0503-0016

Expiration Date:

INTRODUCTION

Thank you for your interest in the U.S. Department of Agriculture’s 1994 Tribal Scholars Program. The USDA 1994 Tribal Scholars Program was established to strengthen the long-term partnership between USDA and the 1994 Land-Grant Institutions by increasing the number of students studying, graduating, and pursuing careers in in food, agriculture, natural resources, and other related fields of study.

Bay Mills Community College - MI

Blackfeet Community College - MT

Cankdeska Cikana Community College - ND

Chief Dull Knife College – MT

College of Muscogee Nation – OK

College of Menominee Nation - WI

Diné College - NM

Fond du Lac Tribal and Community College - WI

Fort Belknap College - MT

Fort Berthold Community College - ND

Fort Peck Community College - MT

Haskell Indian Nations University - KS

Ilisagvik College - AK

Institute of American Indian Arts – NM

Keweenaw Bay Ojibwa Community College- MI

Lac Courte Oreilles Ojibwa Community College - WI

Leech Lake Tribal College – MN

Little Big Horn College - MN

Little Priest Tribal College - NE

Navajo Technical University – NM

Nebraska Indian Community College - NE

Northwest Indian College - WA

Oglala Lakota College - SD

Saginaw Chippewa Tribal College - MI

Salish Kootenai College - MT

Sinte Gleska University - SD

Sisseton Wahpeton College - SD

Sitting Bull College - ND

Southwestern Indian Polytechnic Institute -NM

Stone Child College - MT

Tohono O’odham Community College - AZ

Turtle Mountain Community College - ND

United Tribes Technical College - ND

White Earth Tribal and Community College - MN

The 1994 Tribal Land-Grant Colleges and Universities are:

The USDA 1994 Tribal Scholars Program is implemented under the USDA Fellows Experience Program (FEP). Tribal Scholars accepted into the program will be accepted under Schedule A in 5 CFR § 213.3102 (r) for temporary appointments not to exceed

4 years based on defined criteria. Upon graduation, Tribal Scholars will not be eligible for noncompetitive conversion to full time employment. However, Tribal Scholars will be eligible to compete for career opportunities at USDA.

AUTHORITIES

• 5 Code of Federal Regulations Part 213—Excepted Service, Student Educational Employment Program—Student Career Experience Program

• 5 Code of Federal Regulations Part 410—Training

• Equity in Education Land Grant Status of 1994

• Executive Order 12015, Permitting students completing approved career-related work-study programs to be appointed to career or career conditional positions in the competitive service

• Executive Order 13562, Recruiting and Hiring Students and Recent Graduates

• Executive Order 13270, Tribal Colleges and Universities (2002)

• Executive Order 13592, Improving American Indian and Alaska Native Educational Opportunities and Strengthening Tribal Colleges and Universities

• Food, Agriculture, Conservation and Trade Act of 1990; P.L. 101-624, Sec. 2501, Sec. 2830

• Federal Agriculture Improvement and Reform Act of 1996

• Farm Security and Rural Investment Act of 2002; P.L. 107-171; H.R. 2646

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays the valid OMB control number, 0503-0016. The time required to complete this information collection is estimated to average 3.5 hours per response, including the time needed for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information.

Privacy Act Advisory Statement

The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with this request for information.

Accordingly, pursuant to the requirements of the Act, please be advised:

1. The authority of the collection of these data is Executive Order 11155.

2. Furnishing the information requested is voluntary.

3. The data will be used for selection of USDA 1994 Tribal Scholars, printing of certificates, and related activities.

4. Other routine uses of the data are for preparation of the public affairs and press releases to news media.

THIS IS A FILLABLE FORM. IF POSSIBLE, PLEASE COMPLETE FORM ON COMPUTER.

Affirmation of Candidacy and Authorization for Release Information:

I, Click here to enter text. , understand that I am a candidate for the honor of USDA 1994 Tribal Scholar, have read the Privacy Act Advisory Statement, and affirm that I wish to be considered. In the event I am named a USDA 1994 Tribal Scholar, permission is hereby given for the release of materials submitted by me for the use of the U.S. Department of Agriculture and the 1994 Land-Grant Institutions as deemed appropriate for purposes of the USDA 1994 Tribal Scholars Program. I further consent to the release of photographs which may be taken of me, by or for the U.S. Department of Agriculture, in connection with the Program.

Signature: Click here to enter text. Date: Click here to enter text.

I am willing unwilling to appear on radio and/or television if such arrangements can be made by the U.S. Department of Agriculture in connection with the USDA 1994 Tribal Scholars Program.

SECTION I: PERSONAL

Prefix: Mr. Mrs. Ms. Miss

Last Name: Click here to enter text. First Name: Click here to enter text. M.I.: Click here to enter text.

Suffix: Click here to enter text. Preferred Name: Click here to enter text.

Sex: Male Female Unknown

U.S. Citizen: Yes No

Telephone: Click here to enter text. Email Address: Click here to enter text.

SECTION II: MAILING ADDRESS

Permanent Address: Click here to enter text.

City: Click here to enter text. State: Click here to enter text. Zip Code: Click here to enter text.

SECTION III: EDUCATION

Name of High School: Click here to enter text.

Location (City/State): Click here to enter text.

Counselor Name/Contact: Click here to enter text.

GPA (4.0 Scale)/or GED Date Received: Click here to enter text.

Currently Enrolled in College? Yes No If YES, Fill out information below

Name of College: Click here to enter text.

Location (City/State): Click here to enter text.

Major(s): Click here to enter text. Minor(s): Click here to enter text.

Advisor’s Name/Contact (if available): Click here to enter text.

SECTION IV: OTHER EDUCATION

List from most to least recent any other school(s) or college(s) attended in the last 4 years

Name of School	Location (City & State)	Dates of Attendance
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SECTION V: ORGANIZATIONS/PROGRAMS

List from the most to least recent any advanced or special programs, or summer courses you have taken.

Course/Program	Name of School	Location (City& State)	Dates of Attendance	Hours/ Week
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SECTION VII: TRANSCRIPTS

If you have not received any college credit, you must provide an official signed and sealed transcript from your high school and include it with your application. If you have received any college credit, you must provide an official signed and sealed transcript from every college or university you have attended and include them with your application. The USDA 1994 Program will accept an unofficial transcript from the college registrar provided it meets the deadline and a receipt from the registrar is included indicating an official, signed transcript is being sent.

SECTION VIII: COURSE OF STUDY

The USDA 1994Tribal Scholars Program offers a year-to-year scholarship for eligible students.

I am applying for:

Place an X in the box that applies.

	1-Year Scholarship Support (student will have completed at least 1 year of coursework in an Associate degree program before award period OR is a rising senior in Bachelor’s degree program
	2-Year Scholarship Support (student will be a new entering student who plans to enroll in an Associate degree program OR is a rising junior in a Bachelor’s degree program).
	3-Year Scholarship Support (student will have completed at least 1 year of coursework in a Bachelor’s degree program OR the first year in an Associate/Bachelor’s program).
	4-Year Scholarship Support (student will be a new entering student who plans to enroll in a Bachelor’s degree program OR the first year in an Associate/Bachelor’s program).

1. Are you currently enrolled in or planning to enroll in an Associate’s Degree (2-Year) Program?

Yes. If yes, please indicate field of study: Click here to enter text.

No

2. Are you enrolled in or planning to enroll in a Bachelor’s Degree Program?

Yes. If yes, please indicate field of study: Click here to enter text.

No.

3. Are you currently enrolled in or planning to enroll in an Associate’s Degree (2-Year) Program and plan with the intention of transferring to Bachelor’s Degree Program elsewhere (“2 + 2 Program”)?

Yes

No

*If you answered NO to questions 1-3, you will need to apply to the school(s) you wish to attend.

4. If yes to questions 1-3, please indicate whether it is your first or second year.

1^st Year

2^nd Year

SECTION IX: EXTRACURRICULAR AND EMPLOYMENT ACTIVITIES

Activity	Dates of Participation	Offices Held	Special Awards, honors, recognition
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List any activities in which you have participated in or outside school, i.e. sports, music, student government, clubs, church, civic, etc.

List all volunteer services or jobs held in the last 3 years.

Volunteer services/Jobs	Name of Employer /organization	Dates of service /employment	Hours /Week	Special Awards
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SECTION X: ESSAY QUESTION

Essay must be addressed to the USDA 1994 Selection Committee

Write a 500-800 word essay describing: 1) What motivates you to consider a career in public service working for the U.S. Department of Agriculture. Include information about your educational and career goals and how this scholarship may assist you to achieve them; 2) How did you became interested in studying food, agriculture, and natural resource sciences or another related discipline in college; and 3) How USDA will benefit if you are selected for the USDA Tribal Scholars Program (immediately and in the long term).

SECTION XI: RECOMMENDATION INSTRUCTIONS

You will need to submit two letters of recommendation from two different sources addressing the following question: “Considering what you know of the applicant’s interests, work habits, and life goals, what is your assessment of the chances that the applicant will be motivated to take advantage of the opportunities available in college and with the USDA?” One recommendation must be from someone who knows your academic work. The second recommendation can be from (as an example) a current or previous school counselor, teacher, principal, tribal college and university president, or employer. Make sure the recommendation is from someone who knows you well and can comment on your abilities.

WHERE TO SEND RECOMMENDATION AND APPLICATIONS
Recommendations will need to be sent to following email address: [email protected] or via regular mail to:

Office of Advocacy and Outreach

USDA 1994 Tribal Scholarship Program

U.S. Department of Agriculture

1400 Independence Avenue, SW.

Stop 0601

Washington, D.C. 20250

Tel: (202) 720-7265

SECTION XII: CHECK LIST

I have read this section, especially those elements detailing the eligibility requirements, schools that I must attend, and the TBD deadline in which my completed application package must be postmarked.

I have included an official signed and sealed transcript or have included an unofficial copy of my transcript from the college registrar and a receipt from the same registrar to indicate the official copy will be received shortly from the schools I have attended and have included any and all in my application package.

I have written my essay and included it in my application.

I have given Letter of Recommendation instructions to my counselor or teacher or other recommender to fill out and will have these sent to the following address:

One of these recommendations will come from someone who knows my academic work.

I have applied to all the schools I want to attend.

I will send all application materials to either this email [email protected] or to

Office of Advocacy and Outreach

USDA 1994 Tribal Scholarship Program

United States Department of Agriculture

1400 Independence Avenue, SW.

Washington, DC 20250

Tel: (202) 720-7265

SECTION XIII: SIGNATURES

Please review this form to make sure you have answered all the questions completely.

I certify that I have completed this application and that all statements are true and accurate to the best of my knowledge. Any false statements may eliminate me from consideration for this scholarship.

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Signature of Applicant

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Date

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Signature of Parent or Legal Guardian (if applicant is under 18 years of age)

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Date

USDA 1994 Tribal Scholarship Program

United States Department of Agriculture

1400 Independence Avenue, SW.

Washington, D.C. 20250

Tel: (202) 720-7265

Email: [email protected]

"The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or

because all or a part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for

communication of program information (Braille, large print, audiotape, etc.) should contact USDA's

TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer."

USDA is an equal opportunity employer.

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