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* 1. Please enter your full legal name

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* 2. Please enter your address
Your check will be mailed to the address you enter below

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* 3. Please enter your email address and phone number

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* 4. Please enter your enrollment number

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* 5. Please upload a copy of your Lummi Nation Tribal ID
Your check will not be mailed if your Tribal ID is not uploaded

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* 6. Please upload a picture of you holding your Lummi Nation Tribal ID
Your check will not be mailed if you do not upload a picture of you holding your Tribal ID

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* 7. Please enter your date of birth

Date

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* 8. BY SIGNING THIS DOCUMENT, I CERTIFY THAT I HAVE AN INABILITY TO MAKE MY MONTHLY LIVING EXPENSES, AND/OR I AM IN ECONOMIC NEED. I WILL CONTINUE TO EMBRACE THE RESPONSIBILITY AS AN ELDER TO PRESERVE, PROMOTE AND PROTECT OUR SCHELANGEN BY PASSING ON MY KNOWLEDGE, OUR TRADITIONS AND PRACTICES TO FUTURE GENERATIONS.

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