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Tribal Enrollmet

Strengthening our culture and community by protecting our land and traditional values, and by empowering our people to be strong and healthy in mind and body.

Cheesh’na Tribal Council

HC01 Box 217

Gakona, AK 99586

907-822-3503

Name*
First Last
Gender
- Male
- Female
Applicant's Maiden Name or Other Name Applicant is Known By
Applicant's Native Name(s)
Date of Birth*
MM slash DD slash YYYY
Date of Death
MM slash DD slash YYYY
Base Roll Member*
- Yes
- No
Place of Birth*
Clan
Race
- Alaska Native
- American Indian
- Asian
- African American
- Hispanic/Latino
- Native Hawaiian or Pacific Islander
- Caucasian/White
- Mixed Race
Hair Color
- Brown
- Black
- Blond
- Auburn
- Chestnut
- Red
- Grey
- White
- Bald
Eye Color
- Brown
- Blue
- Grey
- Green
- Hazel
- Violet
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Physical Address
Street Address Address Line 2 City State ZIP Code
Personal Email
Work Email
Home Phone
Work Phone
Cell Phone
Message Phone
Biological Mother
Mother's Clan
Biological Father
Father's Clan
BIA CIB Degree of Native Blood Claimed

Athabaskan, Aleut, Tlingit, Eskimo, Other (specify)
Tribal Enrollment
Tribe
Clan
Enrollment #
Date
MM slash DD slash YYYY
- Add Tribe
Tribe
Clan
Enrollment #
Date
MM slash DD slash YYYY
- Add Tribe
Tribe
Clan
Enrollment #
Date
MM slash DD slash YYYY
Mother's Enrolled Tribe
Father's Enrolled Tribe
Maternal Grandmother
ANSCA Enrollment Information
Maternal Grandfather
ANSCA Enrollment Information
Paternal Grandmother
ANSCA Enrollment Information
Paternal Grandfather
ANSCA Enrollment Information
ANSCA Corporate Shares
Corporation
# of Shares
Enrollment #
- Add Corporate Share
Corporation
# of Shares
Enrollment #
- Add Corporate Share
Corporation
# of Shares
Enrollment #
IHS Record Number
Local IHS Provider/Clinic
Additional Notes or Attachments
File
Max. file size: 512 MB.
Certified Birth Certificate on File
- Yes
- No
Certificate of Indian Blood on File
- Yes
- No
Please attach or email a recent photo for identification card or request a digital photo be taken at the tribal office.
Max. file size: 512 MB.

Cheesh’na Tribal Council
HC01 Box 217
Gakona, Alaska 99586

(907) 822-3503

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