REQUEST FOR OFFICIAL
CERTIFICATE OF INDIAN BLOOD
The Office of Navajo Nation Scholarship and Financial Assistance requires an official Certificate of Indian Blood (CIB) to determine
eligibility for scholarship or financial assistance. An official CIB must be obtained through the Navajo Nation Office of Vital Records-
Tribal Enrollment Services. This form is to assist you with your request for an official CIB.
Dear Navajo Nation Office of Vital Record:
I am applying to the Office of Navajo Nation Scholarship and Financial Assistance (ONNSFA) for financial assistance. The ONNSFA
requires an official Certificate of Indian Blood (CIB). To assist with your efforts I am providing the following information:
Applicants Name:
Census No.
Date of Birth:
Place of Birth:
Legal Spouse’s Name:
Father’s Name:
Mother’s Maiden Name:
Permanent Address:
Applicant’s Signature:
Date:
Please mail my Official CIB to:
_____ONNSFA Chinle Agency, P.O. Box 25-B, Tsaile, AZ 86556
_____ONNSFA Crownpoint Agency, P.O. Box 1080, Crownpoint, NM 87313
_____ONNSFA Ft. Defiance Agency, P.O. Box 1870, Window Rock, AZ 86515
_____ONNSFA Shiprock Agency, P.O. Box1349, Shiprock, NM 87420
_____ONNSFA Tuba City Agency, P.O. Box 370, Tuba City, AZ 86045
Applicant, send this form to your Agency Office of Vital Records:
Navajo Nation Office of Vital Records
Chinle Agency Office of Vital Records
Tuba City Office of Vital Records
P.O. Box 9000
P.O. Box 2527
P.O. Box 1510
Window Rock, AZ 86515
Chinle, AZ 86503
Tuba City, AZ 86045
(928) 871-6386/6387
(928) 674-2279
(928) 283-3404
Crownpoint Office of Vital Records
Fort Defiance Office of Vital Records
Tohajjiilee Office of Vital Records
P.O. Box 148
P.O. Box 290
P.O. Box 108
Crownpoint, NM 87313
Fort Defiance, AZ 86504
Tohajiilee, NM