APPLICATION  FOR REGISTRATION
TO THE NATIONAL REGISTER
ACCORDING TO THE CITIZENSHIP CODE OF
THE METIS NATION IN QUEBEC
APPLICANT
I request that I and my minor children, if eligible, be registered as Metis citizens, that our names be entered in the National Register, as provided under the Citizenship Code of the Metis Nation in Québec.
FAMILY NAME:________________________________________________
GIVEN NAME:__________________________________________________
ADDRESS:_____________________________________________________
TOWN:___________________________    POSTAL CODE:____________
PROVINCE / TERRITORY /STATE:________________________________
BIRTH DATE:  _______/_______/______S.I.N.:  _______/_______/_______
TEL(HOME): (___)____-_______ TEL(WORK): (___)____-_______
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CHILDREN
If you have children under the age of 18, please list the names and birth dates of each on this page and attach a long form birth certificate for each showing the names of both parents.
Children who have reached the age of 18 must complete a separate application form and also provide a copy of the long form birth certificates which indicate the names of both parents.
    BIRTH DATE          FAMILY NAME        GIVEN NAME
____/___/____    ____________   _____________
____/___/____    ____________   _____________
____/___/____    ____________   _____________
____/___/____    ____________   _____________
____/___/____    ____________   _____________
____/___/____    ____________   _____________
____/___/____    ____________   _____________
____/___/____    ____________   _____________

_________________________________
            Applicant's Signature                 Date: _______/_______/_______

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GENEALOGY REFERENCES
Please  provide  reference papers showing that your ancestry comes from a person who is a Métis from North America OR of a person who is a member or a citizen of a First Nation in North America AND a person who is a member or a citizen of one of the Nations of newcomers who settled in North America.
Indicate the names of family members  mentioned in your documents  in a genealogical "Family Tree" (example attached) format.
LIST OF DOCUMENTS AND REFERENCES
[Please attach copies - Do not mail originals]
1.____________________________________________________________
2.____________________________________________________________
3.____________________________________________________________
4.____________________________________________________________
5.____________________________________________________________
6.____________________________________________________________
7.____________________________________________________________
8.____________________________________________________________
If your reference papers do not conclusively establish that you are a Metis, you can include with your application the form below titled "Declaration  of Metis Identity."

 

Page 3

GENEALOGY FORMAT
This is an example of a genealogy format you might use.  There are similar formats with a greater number of generations which you can download on line, fill out, and attach to your application.
______________________________________(Great-grandfather) Date of Birth:       /    /     .   Date of Death:       /    /      .
____________________________________(Grandfather)
Date of Birth:     /     /   Date of Death     /     /    .
 _____________________________________(Great-grandmother) Date of Birth:     /  /   . Date of Death     /  /    .
______________________________________(Father)
Date of Birth:     /  /   .     Date of Death     /  /    .
______________________________________(Great-grandfather) Date of Birth:     /  /   . Date of Death     /  /    .
______________________________________(Grandmother)
Date of Birth:     /  /   .     Date of Death     /  /    .
_____________________________________(Great-grandmother) Date of Birth:     /  /   . Date of Death     /  /    .


______________________________________(Applicant)
Date of Birth:         /     /        .

______________________________________(Great-grandfather) Date of Birth:     /  /   .     Date of Death     /  /    .
_____________________________________(Grandfather)
Date of Birth:     /  /   .     Date of Death     /  /    .
____________________________________(Great-grandmother) Date of Birth:     /  /   . Date of Death     /  /    .
______________________________________(Mother)
Date of Birth:     /  /   .     Date of Death     /  /    .
____________________________________(Great-grandfather) Date of Birth:     /  /   . Date of Death     /  /    .
______________________________________(Grandmother)
Date of Birth:     /  /    . Date of Death     /  /    .
___________________________________(Great-grandmother) Date of Birth:     /  /   . Date of Death     /  /    .
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You must foward your application with : 

(1) a certified passport photo ;

(2) a certified cheque or money-order in the amount of $25.00, payable to:

" Le Secrétariat de la Nation Métis au Québec."

[In the event a card cannot be issued for you, your cheque or money order will be returned.]

(3) Pages one to three of this application form, completed as far as possible.

(4) Copies of reference papers referred to on page three of this application form.

(5) A family tree indicating your relationship to Metis or Indian and non-Aboriginal ancestors.

(6)  A declaration of Metis identity (page six) if documented references are not available.
Send your application to: 

Le Secrétariat de la Nation Métis au Quebec, 
P.O. Box 89, 
Ile-du-Grand-Calumet, 
Quebec, J0X 1J0. 

We will be pleased to send your Citizenship Certificate if you meet all the conditions required by the Citizenship Code of the Metis Nation in Quebec. The Métis Nation in Québec declares that the Nation cannot not be held responsible for a false declaration made by or falsified documents provided by applicants.

 
 
 
 

Page 5





DECLARATION OF METIS IDENTITY

This form permits the Certification of Metis Identity in the event an applicant is not able to provide sufficient written documentation relating to being Metis, and wishes, according to ARTICLE  7 of the citizenship code of the Metis Nation in Québec, to use a traditional process to validate Metis identity.

In order to accept this declaration as sufficient and final proof, it must be accompanied by the form entitled ÏCertification of Metis IdentityÓ attesting that the applicant participated in the traditional  process and following this process, the Elders have declared that the applicant has been recognized as a Metis.
 

APPLICANT
 

FAMILY NAME:_______________GIVEN NAME:__________________

ADDRESS: ______________________________________________________________

TOWN:_________________________      POSTAL CODE: ___________

PROVINCE/TERRITORY/STATE:  ______________________________

TEL.__________________
 

BIRTH DATE:____/____/____      S.I.N.:  _______/_______/_______

 I swear that I am a Metis and that my origins derive from persons of a North American First Nation and from a Nation of the Newcomers in North America; but for reasons beyond my control, it is impossible for me to bring sufficient conventional written proof of this identity. However, I am requesting, of my own free choice, that the Peace Tribunal of the Metis Nation in Quebec will proceed with the traditional process of validation of Metis Identity necessary to complete my declaration.
 
 
 

____________________________________
            Applicant's Signature
                                                              Date:_______/_______/_______
 


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CERTIFICATION OF METIS IDENTITY

ELDERS  ATTESTATION

Whereas the undersigned Elders witnessed the applicant participating in  the traditional process of validation of Metis identity, and who were the witnesss for the applicant, this form, supported by the signed statement of two  Elders, confirms  the identity of  the undersigned applicant as being Métis.

ELDERS

FAMILY NAME:_____________ GIVEN NAME: ___________________

FAMILY NAME:_____________GIVEN NAME: ____________________

Being Elders, citizens of the Metis Nation in Quebec,  or of a First Nation, we certify that the following applicant,

APPLICANT

FAMILY NAME:___________________ GIVEN NAME:___________________

ADDRESS: ___________________________________________________

TOWN: ________________________  POSTAL CODE:_____________

PROVINCE / TERRITORY / STATE:____________________________

BIRTH DATE:____/_____/____          S.I.N.:  _______/_______/_______

TEL. # (HOME):  (____) ____-__________TEL. # (WORK):  (____) ____-__________

has , at his own written request, participated in a traditional  process to validate his Metis Identity at______________________ dated ______________________  and has been declared before us, Elders and principal witnesses, as a Metis of North America. The person who directed the traditional ceremony was

_____________________________________________.

In witness whereof, as Elders, we have signed in witnesses of this ceremony of  the traditional process of validation  of the Metis Identity.

_________________________________________
                          Elder Signature                   Date: _____/_____/_____

_________________________________________
                           Elder Signature                  Date: _____/_____/_____

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