Coronavirus Emergency Food & Essential Supply Assistance for all Tolowa Dee-ni’ Nation Citizens 18+ yrs old

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.

Question Title

* 1. What gift card would you prefer?

Safeway (& Albertson's)

Grocery Outlet

Walmart

No Preference

Question Title

* 2. Name and delivery address

Name *

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address

Phone Number

Question Title

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

Question Title

* 4. Age Statement

I am at least 18 years old, as of May 31, 2020.

Question Title

* 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.

I agree

Signed (Type your name in box)

Question Title

* 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:

Coronavirus Emergency Food & Essential Supply Assistance for all Tolowa Dee-ni’ Nation Citizens 18+ yrs old

Question Title

* 1. What gift card would you prefer?

Question Title

* 2. Name and delivery address

Question Title

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

Question Title

* 4. Age Statement

Question Title

* 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.

Question Title

* 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:

* 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: