Dear Citizen,
To help you during this extraordinary coronavirus pandemic,
we are distributing a gift card, to be used for food & household supplies.

To do this, we need to confirm your address, and secure your agreement that the funds will only be used for food & supplies.

(Any food items, and any essential supplies such as: toilet paper, paper towels, sanitizing & cleaning items, soap, medicine, etc.)

Every Tolowa Dee-ni’ Nation Tribal Citizen, 18 years and older, is eligible to receive the funds.

We know more is needed, & we are applying for additional relief dollars.
For now, please use these funds to aid you & your family during the emergency.

To receive your gift card, please provide your information, and sign the agreement.

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* 1. What gift card would you prefer?

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* 2. Name and delivery address

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* 3. Last 4 digits of your Tolowa Dee-ni' Nation enrollment number/tribal ID  

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* 4. Age Statement

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* 5. I do swear and attest that by submitting this form, any funds will only be used for food, household supplies, masks, medicine, or similar essential expenses.

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* 6. There are other assistance programs underway, such as food distribution and housing assistance.

Please let us know about any other urgent needs you & your family have at this time:

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