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ShadęlChampagne

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Application Form For Enrollment under CAFN Final Agreement

Application Form For Enrollment under CAFN Final Agreement

Information about the Parent/Guardian

Are you the parent/guardian of a minor child applying on their behalf to have the child enrolled under CAFN?

Yes

No

Hidden

Section Break

Are you (the parent/guardian) currently enrolled with CAFN?

Yes

No

Name

First Last M.I.

Birth Date

DD slash MM slash YYYY

Address

Street Address Address Line 2 City Province Postal Code

Phone

Email

If you are over 17 years of age (ie 18+), you can apply on your own behalf.

Hidden

Section Break

Information about the applicant

Name

First Last

Date of Birth

DD slash MM slash YYYY

Other Legal Names

Address

Street Address Address Line 2 City Province Postal Code

Phone

Email

Are you adopted?

Yes

No

Please provide documentation

Max. file size: 128 MB.

Canadian citizen?

Yes

No

Citizenship

Elegible for STATUS under the Indian Act?

Yes

No

Status Number

Name of Mother

First Last

Name of Father

First Last

Have you ever been enrolled under CAFN?

Yes

No

Did you terminate/transfer enrolment to another First Nation?

Yes

No

Date of termination/transfer

DD slash MM slash YYYY

Are you enrolled / do you receive benefits under any other First Nation Final Agreement or Land Claim Settlement (in or outside Canada)?

Yes

No

Which First Nation Final Agreement or Land Claim Settlement?

Establishing Eligibility for Enrolment under CAFN

Lineal means of a family relationship that includes mothers, fathers, daughters, sons, grandparents, grandchildren, etc, but not siblings, cousins, etc.

Are you a lineal descendant of Champagne and Aishihik dän (person)?

Yes

No

Please attach the filled family tree (find the PDF at the bottom of the page)

Max. file size: 128 MB.

Do you (the applicant) have a current and substancial connection to CAFN?

Yes

No

Please explain fully and in detail:

Do you have a family connection to a traditional Champagne and Aishihik First Nation dän nàjè yu (settlement) (ie. Dakwäkäda (Haines Junction), The Yänlin Chemi (Canyon Creek), Nàkhu/Takhini , Chu'ena Kéyi (Hutchi), Äsheyi (Aishihik), Shadhäla (Champagne)) ? Please explain in full detail.

What is your family connection?

To which traditional CAFN dän nàjè yu (settlement) are you connected and if so how are you connect?

How often do you visit the dän nàjè yu (settlement)?

Do you take part in gatherings in your dän nàjè yu (settlement) (ie. pottatches, general assemblies, community meets and/or celebrations/events?

How do you give back/contribute to you dän nàjè yu (settlement)?

Do you have a family kwändur (story) about the life within Champagne and Aishihik First Nations dän nàjè yu (settlement) or village and are you willing to fullfill your responsability to keep your kwändur alive within your family and community? Please explain fully and in detail:

Do you have an affiliation with a Champagne and Aishihik First Nation Clan?

Yes

No

Please explain wich clan:

Do you have a Champagne and Aishihik First Nation dan yizhi (traditional name) that was bestowed upon you at birth or at a Potlatch and if do what is your traditional name? Please explain fully and in detail

Do you speak or understand a First Nation language? Please explain fully and in detail

Signature of Applicant

Consent

I certify that my answers are true and complete to the best of my knowledge.

Signature of applicant

Date

MM slash DD slash YYYY

*APPLICANTS PARENT/LEGAL GURADIAN/ADOPTIVE PARENT (SIGN ON BEHALF OF MINOR)

Mother's Signature

Date signed

DD slash MM slash YYYY

Father's Signature

Date signed

DD slash MM slash YYYY

Δ

HAINES JUNCTION OFFICE

#1 Allen Place, P.O. Box 5310
Haines Junction, YT Y0B 1L0
867-634-4200

WHITEHORSE OFFICE

304 Jarvis Street
Whitehorse, YT Y1A 2H2
867-456-6888

COMMUNITY BUILDINGS

Takhini Hall 867-667-6701
Da Ku Store 867-634-3307
Youth Center 867-634-2012
Mun Kų 867-634-7001
Champagne Hall 867-634-2336
Klukshu Hall 867-634-2342

contactus@cafn.ca

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