Enrollment Address Change Form

Enrollment Address Change Form

Please select one of the following:*

Parent/Guardian

Self

Last Name:*

First Name:*

Middle Initial:

Suffix:

Date of Birth:*

Address:*

City:*

State:*

Zip Code:*

Telephone Number: *

Phone

Email Address:*

I am:*

Native

Non-native

Tribal ID Number:*

Household Information:

How many Puyallup Tribal Children, 17 years old and younger, reside in your household?*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Child's First Name:*

Last Name:*

MI:

Date of Birth:*

Social Security Number:*

Relationship to child:*

Child's Tribal ID Number:*

Identification and Custody Paperwork File Upload

File Upload*

Please upload all required documents here.

Required Documents include:

Identification (Accepted Identification: Tribal ID, State ID or passport ID).
If you are changing the address of a minor, you must upload court ordered documentation for minors in need of care or power of attorney papers (legal documents).

Drag and drop files here or

Would you like this information forwarded to other departments?*

Accounting

Per Capita

No, I only want Enrollment to have this information.

Applicant Full Name:*

Today's Date:*

I certify that all the information provided herein is accurate and complete to the best of my knowledge. By signing this application, I agree to comply with the terms, policies and procedures.**

If you have any questions, please email Enrollment@PuyallupTribe-nsn.gov.

If you want a copy of your submission, remember to check the box at the end of the application.

Send me a copy of my responses

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