Fillable SHAREHOLDER AUTHORIZATION TO RELEASE INFORMATION (Ilisagvik College)

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SHAREHOLDER AUTHORIZATION TO RELEASE INFORMATION (Ilisagvik College)

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SHAREHOLDER AUTHORIZATION TO RELEASE INFORMATION
Dear Student/Participant:
Ilisagvik College is an accredited institution and one of 37 tribal colleges nation-wide. As a federally
recognized tribal college, the College receives some of its funding from the federal government and must
provide proof that a certain percentage of the student body is American Indian, Alaska Native, Hawaiian
or part of another First Nations People. Your information serves only to verify that Ilisagvik College
meets that criterion.
Thank you.
Birgit Meany,
Dean of Academic Affairs
By completing the informational items below, I hereby authorize the corporation indicated below to
provide Ilisagvik College with a verification of my enrollment as a shareholder.
Ahtna, Incorporated
Aleut Corporation
Arctic Slope Regional Corporation
Bering Straits Native Corporation
Bristol Bay Native Corporation
Calista Corporation
Chugach Alaska Corporation
CIRI
Doyon, Limited
Koniag, Inc.
NANA Regional Corporation
SEALASKA
Other:________________________________
First Name (Print)
Last Name (Print)
Social Security #
Date of Birth
Date
Phone Number
E-mail address
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SHAREHOLDER AUTHORIZATION TO RELEASE INFORMATION (Ilisagvik College)

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Completed 25 July 2020

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