Confirmation of Aboriginality

Identity

Full legal name *

Date of birth

Mobile

Email *

Address

Cultural information

Nation / Clan

Traditional Country

Family surnames

Community affiliations

Elders / community members known to you

Purpose of confirmation

Purpose

Kinship

Mother's family

Father's family

Grandparents

Communities connected to

Existing DIYDG board / community connections

Board verification

Which board member can verify your connection?

Have they spoken to you before?

Supporting organisations

Supporting documents

Family genogram

Statutory declaration

Community letters

Centrelink forms

Supporting ID

Declarations

The information I have provided is truthful and accurate.I consent to the board verifying the information provided.

Signature (type your full name)