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Aquinnah Wampanoag Survey

        Please provide as much information possible for each question of each section. It’s very important that all information given be accurate.

       A separate survey is to be completed for each individual enrolled member of THIS tribe over eighteen years of age, even if they are listed as dependants by their parents. Request for information regarding dependants and/or spouse should be filled out completely to the best of your ability whether the individuals are Tribal member(s) or Non-Tribal member(s). NOTE: Two enrolled tribal members of this tribe that are married to each other need only complete one form for the two of them and their minor children.

Section 1    Individuals completing this survey should list all personal data regarding name, address, and tribal membership status, voting status, etc.

Section 2    Please list all family members living in your household or abroad. Complete all questions to the best of your knowledge.

Section 3    Question “Describe repairs needed to Dwelling” you should describe in detail any structural deficiencies. For instance, if the roof is leaking, write leaky roof. Do not simply write, “roof”.

Section 4    List your current employment status.

Section 5    List your gross individual and family incomes where indicated. Gross being defined as all wages, tips, and earnings before taxes.

Section 6    Physically Handicapped is the defined as receiving state or federal assistance as a result of a permanent injury or condition.

Section 7    Please list in this section the form(s) of childcare you are currently using weather they are family, preschool, or other including the costs.  Any input or suggestions regarding childcare services would be appreciated.

Section 8    Check off the highest level of education you have completed.

           NOTE: The information collected in the survey will be used to help provide services to members. This information is also used by federal organizations for determining eligibility for funds to be used by the tribe.

Click on the link below to fill out Aquinnah Wampanoag Survey!
Aquinnah Tribal Members Only! Aquinnah Wampanoag Survey.pdf

For a Free version of Adobe Reader click on the link below

Wampanoag Tribe of Gay Head (Aquinnah) 20 Black Brook Road, Aquinnah, MA 02535-1546
Phone: (508) 645 9265    Fax: (508) 645-3790    Monday through Friday, 9 am to 5 pm
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