PFS School Supplies 2024

Partners For Success

APPLY FOR SCHOOL SUPPLIES · FALL 2024
You may also download a printable version of this form here:

PFS School Supply Application (PDF)
When was the last year you child received school supplies?*
Applicant Information
Student/Youth's Full Name*
Age*
Date of Birth*

MonthDayYear
Social Security Number*
Address*

Address

Street Address Line 2

CityState

Zip
Gender

FemaleMaleOther
Phone Number*
Message Phone
Name/Relation (for this phone number)
Email Address*
username@website.com
Village/Tribe*
Home - Physical Address*
Streets, Landmarks, Etc.
Parent/Guardian’s Name (if under 18 years of age)
Referred by:*

Self/Walk-InL-A High SchoolVocational RehabTribal CourtOther

Required Documents

In order to activate your PFS application for services and/or determine eligibility, please provide the additional documents for your Student/Youth below.
You can upload a photo or scanned copy of the documents required.

You may also bring physical copies to the PFS office to accompany your application, or email them to: k.riley@lagunaed.net
Identification: Age

Provide ONE document from the options below:
Select one:

Birth Certificate
Upload a file that shows proof of age

Example files: PNG, GIF, JPG, PDF
Cancelof
Proof of Residence - Household

Provide ONE document from the options below:
Select one:

Utility BillVoter RegistrationPostmarked Mail
Upload a file that shows proof of residence

Example files: PNG, GIF, JPG, PDF
Cancelof
Verification of Indian Blood

Provide ONE document from the options below:
Select one:

Tribal Enrollment CardCertificate of Indian Blood (CIB)
Upload a file that shows proof of Indian Blood

Example files: PNG, GIF, JPG, PDF
Cancelof
Social Security

Provide the required document below:
Social Security Card
Upload a file that shows proof of a Social Security Card

Example files: PNG, GIF, JPG, PDF
Cancelof
CERTIFICATION

I certify that the information contained on this application is true and correct to the best of my knowledge. I understand that all information provided is subject to review and verification. I have provided all documents that were requested to support this application. I am also aware that I am subject to be dismissed if I am found ineligible after enrollment. I allow the release of this information for verification purposes and I understand that it will be used to determine my eligibility. If accepted I agree to abide by all rules, regulations and procedures of the Pueblo of Laguna Partners for Success.
Signature

Clear
Date

MonthDayYear
Parent/Guardian's Signature

Clear
Date

MonthDayYear
Should be Empty:

Partners For Success

Applicant Information

Barriers/Offender Barriers/At Risk

Required Documents

Identification: Age

Proof of Residence - Household

Verification of Indian Blood

Social Security

CERTIFICATION