PARENT/GUARDIAN APPLICATION CHECKLIST

PARENT/GUARDIAN APPLICATIONCHECKLISTUse this Checklist to ensure you have completed all parts of the application form and included allrequired documents with your submission. Clearly label all the support documents, and list themAPPLICATION SUBMITTED AS: IndividualOR Part of a Family PackageName of MAIN APPLICANT:in the spaces provided below. List all documents, using additional paper if needed.Child/ward’s NameChild/ward’s AddressParent/Guardian’s NamePhoneParent/Guardian’s Mailing Address (if different than Applicant’s)The Applicant is: My child My child is subject to a custody order and I have attached the Court Order granting me custody My ward Court Order granting me guardianship attachedPart 1: Personal Information Long-form birth certificate Marriage certificate (if applicable) Court-appointed adoptions papers (if applicable) Court documents indicating legal name change (if applicable) Resolution from a local Mi’kmaq organization supporting Mi’kmaq adoption Affidavits supporting Mi’kmaq adoptionPart 2: Statements Read, signed, and dated by Parent/GuardianPart 3: Aboriginal Ancestry Proven Aboriginal ancestor: ___________________________________List all support documents submitted for this ancestor. Use additional paper if needed. Documents demonstrating my child/ward’s ancestor as Aboriginal: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Documents supporting my child/ward’s relationship to each ancestor on the Ancestry Chart: Parent: ________________________________________________________________ Grand-parent: __________________________________________________________ Grt. Gr-parent: __________________________________________________________ Grt. Grt. Gr-parent: ______________________________________________________ Grt. Grt. Grt. Gr-parent: __________________________________________________ Grt. Grt. Grt. Grt. Gr-parent: _______________________________________________ Grt. Grt. Grt. Grt. Grt. Gr-parent: ___________________________________________

PARENT/GUARDIAN APPLICATION CHECKLIST (con’t)Part 4: Mi’kmaq Community / Pre-ConfederationPart 4A Documents supporting my ward’s community, if it is not listed on page 17 of the guidelines: ________________________________________________________________ ________________________________________________________________ Part 4.1: Documents demonstrating my ward’s residency in the community: ________________________________________________________________ ________________________________________________________________OR Part 4.2: Documents demonstrating my ward’s connection to the community and his/her maintenance of the Mi’kmaqway of life: ________________________________________________________________ ________________________________________________________________Part 4B Documents supporting the community of my child/ward’s ancestor if it is not listed on page 17 of the guidelines: ________________________________________________________________ ________________________________________________________________ Part 4.3: Documents demonstrating the residency of my child/ward’s ancestor in the community: ________________________________________________________________ ________________________________________________________________OR Part 4.4: Documents demonstrating my child/ward’s ancestor’s connection to the community and his/her maintenance ofthe Mi’kmaq way of life: ________________________________________________________________ ________________________________________________________________Part 5: Mi’kmaq Membership: Current Documents supporting my child/ward’s community if it is not listed on page 22 of the guidelines: ________________________________________________________________ ________________________________________________________________ Part 5.1: Documents demonstrating my residency if the child/ward lives with me, ORdocuments demonstrating residency of the person with whom my child/ward resides in the community: ________________________________________________________________ ________________________________________________________________OR Part 5.2: Affidavits demonstrating my child/ward’s connection to the community: ________________________________________________________________ ________________________________________________________________AND Documents demonstrating my child/ward’s maintenance of the Mi’kmaq way of life: ________________________________________________________________ ________________________________________________________________Part 6: Full and Final Release Signed, dated, and witnessed by Parent/Guardian on behalf of the child/ward