I HEREBY AUTHORIZE RELEASE OF ANY INFORMATION SHOWN ON THIS APPLICATION, TRANSCRIPTS, AND REFERENCES AS MAY BE REQUIRED BY THE SCHOLARSHIP COMMITTEE. I CERTIFY ALL INFORMATION PROVIDED HERE TO BE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.
 
 

Applicant's Signature _____________________________________

Date ___________________
 
 

American Indian Club Interest

Please let us know if you are interested in being part of a group of students who would like to meet and support each other. One activity will be to participate in the West Valley College Powwow. Fill in the information and return with application.

Name: ________________________________

Address:_________________________________________________________

City, ZIP ____________________     _________

Phone # ________________________________

College  _______________________________