Administration for Native Americans Registration Form

OMB #: 0970-0617

Expiration Date: 09/30/2026

Administration for Native Americans Registration Form

*First Name

*Last Name

Preferred Name

*State

*Email

Job Title

*Tribe/Organization (Please enter the full name of your tribe/org, do not use abbreviations or acronyms)

*Phone Number

Grant Number

UEI Number (SAM.gov)

*Are you a consultant?

Yes (If so, you must provide a signed letter on organization stationery to attend)

No

*How did you hear about this training?

• ANA Regional TTA Center Newsletter

• Social Media

• ANA Regional TTA Center Website

• Word of mouth

• Other

*Will you require any special assistance or accommodations for this training session?

Yes/No

Would you like to receive a manual by email or by mail, if applicable?

If yes, please complete applicable fields:

Email

Mail (Please provide your mailing information below)

Street Address

City

State

Zip Code

(For Project Planning and Development only)

Project Idea

To make the most out of this Pre-Application training and help your organization prepare a strong ANA grant application, you should attend this training with a project idea to work on. Please describe your project idea here.

Stay informed on the latest ANA webinars, funding opportunities, and free training events. Please subscribe me to the ANA Regional TTA Center listserv.

Yes

No

*Required field

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this request is to provide ANA with information to facilitate effective training and workshop experiences. Public reporting burden for this collection of information is estimated to average 10 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0617 and the expiration date is 09/30/2026. If you have any comments on this collection of information, please contact Amy Zukowski at [email protected].