New EnrollmentApplication

Personal Information

Last name

Given name

Previous name

Nicknames

Date of birth

Place of birth

Gender

Citizenship

Address

City

Province

Postal code

Mailing Address (if different from home)

City

Province

Postal Code

Main phone

Work phone

Children Information

Add Child

Back

Nova Scotia Mi'kmaw Ancestry

*Q1. Do you have an ancestral connection to one of the 13 Nova Scotia Mi'kmaw Bands?

Q2. Which Nova Scotia Mi'kmaw bands and/or areas do you belong to, or have ancestral connection to?

Nova Scotia Band

*Q3. Do you have ancestral connections through birth or adoption, to at least one Nova Scotia Mi'kmaw family?

Q4. If you do not have ancestral connection to a Nova Scotia Mi'kmaw family, but currently are a band member of one of the 13 Nova Scotia Mi'kmaw Bands, is this because you gained Indian Status through marriage?

If no, please explain:

Q5. Do you have Indian Status?

Q6. How did you gain Indian Status?

Q7. Did you ever lose Indian Status?

Q8. Have you been adopted?

If "Yes", please complete:

Adoption Type:

Adoption place

Adoption age

Back

Personal Statement

The Enrollment Committee may look for further demonstration of community and family connections through the submission of your Personal Statement, and will ask questions during "Pitewey Time".

* Personal Statement: Consider the following areas and write your personal statement in 200 words or less:

Knowledge of Mi'kmaw culture and traditions
The ways in which you participate in the Nova Scotia Mi'kmaw Nation
Your contribution, acceptance and connection to the Nova Scotia Mi'kmaw Nation
Your family and community connections

Back

Mi'kmaq Family Connections

Add Connection

Back

Appointment of Representative (Optional)

Is the applicant an adult under a legal disability or incapacity?

Do you want to appoint a person to make enquiries about your application on your behalf (e.g. legal counsel, family member)?

Representative Information

Last Name

Given Name(s)

Home/Cell Phone

Work Phone

Relationship

Business Name/Company of Representative (if applicable)

Authority to Disclosure of Information

Click to initial

I hereby authorize the Enrollment Committee to release information about my Application to the enrollment/ Business/ Company named above. I understand that the authorization will remain effective until the Enrollment Committee has completed its assessment of my Application, or until I withdraw or change this authorization by so advising the Enrollment Committee in writing. I understand that while my representative may accompany me to any interview with the Enrollment Committee, my representative will not be permitted to answer interview questions on my behalf.

Back

Declaration

Please note: Submitting false information in an Application may result in its rejection.

I understand that as a Nova Scotia Mi'kmaq, that with Rights come Responsibilities, and I commit to adhering to these Responsibilities.

Click to initial

I agree to solemnly declare that the facts contained in this application are true to the best of my knowledge.

Back

Privacy Notice

The purpose of this Application under the Nova Scotia Mi'kmaw Enrollment Process is to determine your eligibility as a beneficiary and rights-holder eligible to exercise Mi'kmaw Aboriginal and Treaty rights in the Province of Nova Scotia, as authorized by the Framework Agreement between the Assembly of Nova Scotia Mi'kmaw Chiefs, Canada, and Nova Scotia.

Personal information about you collected by the Enrollment Office and/or Enrollment Committee will be used for the limited purpose of assessing your eligibility for enrollment as a Mi’kmaw of Nova Scotia under the Nova Scotia Mi'kmaw Enrollment Process, to fulfill their duties as set out in the Enrollment Process, and to keep you informed about the status of your Application. If your Application is rejected and you choose to file an appeal, the Enrollment Office will provide your Application file to the Appeals Committee. The Enrollment Office may also use your information to develop aggregate statistical information for policy analysis, research, and/or communications.

Click to initial

I agree that I have read and understood this privacy notice, and consent to the collection of my personal information by the Enrollment Office as set out above.

Consent to Electronic Communication

The Enrollment Committee may need to communicate with you concerning your Application, and such communications may include your personal information. Although the Enrollment Committee will endeavour to protect the privacy of your personal information, the Enrollment Committee cannot guarantee the security or integrity of any information sent over the Internet or by electronic means.

Click to initial

I Agree to communicating with the Enrollment Committee and the Enrollment Office by email or other electronic means using the following email address:

Back