Application for membership in the
Metis Nation of the South

Be sure to keep a copy for your records!

Application Instructions: Please use your web browser (Under "edit" choose "select all", then "copy") to copy the information below into your word processing program or the body of an email message. (Open a "new document" in your word processing program or "new message" in your email program, then select "edit" and "paste".) Be sure the cursor is in the message area of your email message. You can then enter your information on the appropriate line. Before sending, you should delete all the Application Instruction information from the top of the application. After you have completed Parts 1 and 2 of the form, send it via email to the MNS.

Part 3 of the application process includes the oath of citizenship and other items that may be pertinent to your application. Please print out Part 3 and complete the appropriate sections. After your initial application has been received, (Parts 1 and 2), you will be contacted directly with details on where to mail Part 3. If you have any questions on the application process, please contact us.

PART 1

APPLICANT'S PERSONAL INFORMATION:

Title: __ Mr. __ Mrs. __ Miss __ Ms.
Last Name:
First Name:
Middle Name:
Nickname:
Other Names Used:

Address One:
Address Two:
City:
Province/State:
Country:
Postal/Zip Code:

Home Phone:
Home Fax:
Home Email:

Place Of Birth:
Date Of Birth:

Height:
Weight:
Hair Color:
Eye Color:
APPLICANT'S EMPLOYMENT INFORMATION
(For Emergency Use Only):

Company Name:
Address One:
Address Two:
City:
Province/State:
Country:
Postal/Zip Code:
Work Phone:
Work Fax:
Work Email:
Position:

Do You Volunteer: _____Yes _____No
(if Yes) What Area:
SPOUSE OR SIGNIFICANT OTHER:

__ No spouse or significant other

Anniversary:

Title: __ Mr. __ Mrs. __ Miss __ Ms.
First Name:
Middle Name:
Nickname:
Other Names Used:
(Please complete a separate application for spouse or significant other.)
MINOR CHILDREN LIVING WITH APPLICANT:

__ No minor children living with applicant

Child One
__ Natural/Step (Please attach copy of Birth Certificate)
__ Adopted (Please attach copy of Adoption Decree)
__ Foster (Please attach copy of Foster Placement Decree)
Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Child Two
__ Natural/Step (Please attach copy of Birth Certificate)
__ Adopted (Please attach copy of Adoption Decree)
__ Foster (Please attach copy of Foster Placement Decree)
Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Child Three
__ Natural/Step (Please attach copy of Birth Certificate)
__ Adopted (Please attach copy of Adoption Decree)
__ Foster (Please attach copy of Foster Placement Decree)
Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Child Four
__ Natural/Step (Please attach copy of Birth Certificate)
__ Adopted (Please attach copy of Adoption Decree)
__ Foster (Please attach copy of Foster Placement Decree)
Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Child Five
__ Natural/Step (Please attach copy of Birth Certificate)
__ Adopted (Please attach copy of Adoption Decree)
__ Foster (Please attach copy of Foster Placement Decree)
Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:
STATEMENTS OF PATERNITY/MATERNITY OF MINOR CHILDREN NOT LIVING WITH APPLICANT:

__ No minor children not living with applicant

"I hereby affirm under penalty of perjury, that I am the natural, non-custodial parent of the below listed minor child.

Child's Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Custodial Parent/Guardian's Name:
Address:
Telephone Number:

"I hereby affirm under penalty of perjury, that I am the natural, non-custodial parent of the below listed minor child.

Child's Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Custodial Parent/Guardian's Name:
Address:
Telephone Number:

"I hereby affirm under penalty of perjury, that I am the natural, non-custodial parent of the below listed minor child.

Child's Name:
Date of Birth:
Place of Birth:
Height:
Weight:
Hair Color:
Eye Color:

Custodial Parent/Guardian's Name:
Address:
Telephone Number:

ATTACH EXTRA PAGES IF NEEDED

PART 2

PATERNAL ANCESTRY WORKSHEET

Father's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Grandfather's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandfather's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandmother's Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Grandmother's Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandfather's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandmother's Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:
MATERNAL ANCESTRY WORKSHEET

Mother's Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Grandfather's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandfather's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandmother's Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Grandmothers Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandfather's Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________
Non-Native Ancestry:

Great-Grandmother's Name:
Maiden Name:
Address:
City, State/Province, Zip/Postal Code
Phone Number:
Date and Place of Birth:
Date and Place of Death:
Native Nation/Tribe:
Status: __ Not Enrolled __ Enrolled, Number: _________

To get to Part 3 of the application, click here


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