Voluntary Self Declaration

• Applicant Name
• Are you an Aboriginal Person? Yes No

If yes, select the option that best describes you

• I am a Status Indian/Treaty Indian.

  I am affiliated with the First Nation and Band (Treaty Number: ).

• I am a Non-Status Indian.

  I am affiliated with the Nation.

• I am Metis.

  I am a member of the Metis association or I am affiliated with the : Metis local/community.

• I am a Inuk/Inuit.

  I enrolled as a beneficiary of the land claim or I am a member of the Labrador Inuit Assoc., or I am affiliated with the Inuk/Inuit Community.

• I declare myself to be an Aboriginal person

  because

Please indicate languages by checking the applicable box or boxes.

	Speak	Read	Write	Understand
Cree
Ojibway
Oji-Cree
French
Ukranian
German
Other