Texas Band of Choctaw Indians
Texas Band of Choctaw Indians
Registration for Enrollment
P.O. Box 562 Overton, Texas 75682/ E Mail: enroll@chahta.org
FULL NAME OF REGISTRANT: ___________________________________________
ADDRESS:
__________________________________________________________________________________________TELE:
(_____)______________ Date of Birth: _________________ Place of Birth: ____________________________Social Security Number (ID only):
_________-_______-_________ SEX: Male ___________ Female ___________NAME OF CHOCTAW (or Mt. Tabor-Cherokee) PARENT (S) OF WHOM ELIGIBILITY IS CLAIMED:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
ARE YOU AN ENROLLED MEMBER OF THE CHOCTAW NATION OF OKLAHOMA? YES: ___ NO: ___
IF YES PLEASE PROVIDE A COPY OF YOUR CDIB WITH THIS APPLICATION.
DO YOU POSSESS BLOOD OF ANY OTHER AMERICAN INDIAN TRIBES/BANDS/NATIONS?
IF SO ARE YOU ENROLLED WITH THEM? YES: _____ NO: ______ (if so) NAME OF INDIAN TRIBE/NATION:
____________________________________________________________________________________________________
IS YOUR BIRTH CERTIFICATE ON FILE WITH THIS OFFICE? YES:
_________________ NO: _______________IF NOT THEN PLEASE SUBMIT ONE WITH THIS APPLICATION.
MARITAL STATUS: (circle one) S M D W O
NAME OF SPOUSE:
________________________________________________________________________________IS YOUR SPOUSE OF INDIAN DESCENT? YES:
______ NO: ______(If yes name of) TRIBE: ___________ENROLLED: YES:
______ NO: ______NAME OF CHILDREN:
___________________________________ __________________________________________
______________________________________________________ _____________________________________________
______________________________________________________ _____________________________________________
Note: Applications must be filled out for each child to be considered for enrollment. Parents or
guardians must sign for each minor child's application to be considered.
SIGNATURE: ________________________________________________________________________________________
Signature of applicant, or parent or guardian of minor
DO NOT WRITE BELOW THIS LINE: CHOCTAW BUSINESS COMMITTEE USE ONLY
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REVIEWED BY: ____________________________________________
APPROVED FOR ENROLLMENT: YES __________ NO: ___________
ROLL NUMBER ASSIGNED: __________________________________
SIGNATURE OF CBC CHAIRPERSON:_________________________________________
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Go to ancestry chart to complete application
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