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* 1. Please check any needs that should be provided through the JOM program to Native American students.

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* 2. My child/children are in the following grade(s): (check all that apply)

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* 3. Please rank these needs from most important to least important. 1 is the most important; 6 is the least important.

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* 4. How do you think your JOM funds could be used to enable Indian Education students to equally participate in any school activities?

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* 5. Please check the category that best describes you: 

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* 6. Tribal Affiliation

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