Child Nationality Registration

* Indicates required field

Name of Parent (National) *

First

Last

Phone Number *

Email *

Street Address *

City *

County *

State *

Zip Code *

NAME OF MOTHER OF CHILD *

WHAT CITY WAS CHILD BORN IN? *

COUNTY & STATE OF BIRTH *

NAME OF FATHER OF CHILD *

CHILD'S DAY OF BIRTH (EX. 00/00/0000) *

HEIGHT AND WEIGHT APPROXIMATELY *

CHILD'S SOCIAL SECURITY BOND # ON BACK OF CARD (PLACE ZEROS IF YOU DON'T KNOW OF REFUSE THIS INFO) *

CHILD'S SOCIAL SECURITY NUMBER *

BIRTH CERTIFICATE NUMBER - STARTS WITH 3 DIGITS (PLACE ZEROS IF YOU REFUSE TO PROVIDE THIS INFO) *

NAME OF ABORIGINAL JURIST WHO REFERRED YOU. ENTER DR. ALI IF NO JURIST REFERRED YOU. *

FULL NAME OF MOTHER & BIRTHPLACE (COUNTY & STATE) *

FULL NAME OF FATHER & BIRTHPLACE (COUNTY & STATE) *

FULL NAME OF GRAND MOTHER & BIRTHPLACE ON MOTHERS SIDE (COUNTY & STATE) *

FULL NAME OF GRAND MOTHER & BIRTHPLACE ON FATHERS SIDE (COUNTY & STATE) *

FULL NAME OF GRAND FATHER & BIRTHPLACE ON MOTHERS SIDE (COUNTY & STATE) *

MATERNAL GREAT GRAND MOTHER *

FULL NAME OF GRAND FATHER & BIRTHPLACE ON FATHERS SIDE (COUNTY & STATE) *

PATERNAL GREAT GRAND FATHER *

CHILD'S FULL INDIGENOUS NAME YOU SELECTED *

HOUR OF BIRTH *

MOTHERS AGE AT TIME OF BIRTH *

HOSPITAL OR HOME/NATURAL BIRTH *

SEX: MALE OR FEMALE *

FATHERS AGE AT TIME OF BIRTH *

PARENTS COMMENT *

UPLOAD PIC OF TRIBAL NATIONALITY CREDENTIALS. (SEE INSTRUCTIONS) *

Max file size: 20MB