The Nez Perce Tribe Financial Assistance Program is for Nez Perce enrolled members ages 18 and older.
Federal Poverty Guidelines shall be applied
All verifications are required with each application
INCOMPLETE applications will be denied
Nez Perce tribal members are allowed one grant per fiscal year
Checks and Purchase orders will be processed within 10 business days

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* 1. CERTIFICATION: I fully understand that Title 18, Section 1001 of the United States Code, states that a person is guilty of felony by knowingly and willingly making false or fraudulent statements to any department or agency of the United States.  I, therefore, certify the foregoing information is true and complete to the best of my knowledge.  I authorize inquires to be made to verify this statement is true.   Funds or purchase orders received fraudulently or not used for approved purpose will result in applicant’s ineligibility to receive Nez Perce Tribal Financial Assistance for 2 years from the date of last application.  Applicant may be required to reimburse the Nez Perce Tribe for the amount of the Financial Assistance grant.

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* 2. Are you an enrolled member of the Nez Perce Tribe

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* 3. Birthdate:

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* 4. Age:

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* 5. Gender:

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* 6. Please list all household members:

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* 7. Are you Employed?

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* 8. What is your  income?

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* 9. I Wish to Apply for:

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* 10. Reason For Request:

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* 11. Name of Vendor:

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* 12. If you would like Direct Deposit Please fill out this portion:

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* 13. Are you Homeless?

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* 14. Are you a Veteran?

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* 15. Tribal ID

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* 16. Income Verification

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* 17. Document of Need (Invoice, Bill)

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* 18. For Office Use Only Finance Requisition
Recommend : Approved or DENY    Initials:_________   Date:______________
Purchase Order:_______    Check:__________
Vendor#:_____________
Vendor:
Amount:
Accountant Initials:
Financial Assistance 1010 01 7045
Elder Assistance 1010 27 7700
Burial Assistance 1010 01 7040
Medical Assistance 1010 01 7045

Originating Employee:
Immediate Supervisor:
Account # If needed:

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