Federal Poverty guidelines at 150% shall be applied. All verifications are required with each application.
INCOMPLETE APPLICATIONS WILL BE DENIED. You may reapply and provide all required verifications.
Recipients must be enrolled in a federally recognized tribe and live on the Nez Perce Reservation.
Please attach the following:
*Tribal Enrollment   

* Verification of Income (for all household members)

* Energy Bill/ Shut off notice (Must be in eligible applicant’s name)

* Social Security Card

Question Title

* 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.

Question Title

* 2. Are you an enrolled member of a federally recognized tribe?

Question Title

* 3. Birthdate:

Question Title

* 4. Age?

Question Title

* 5. Gender:

Question Title

* 6. Are you Employed?

Question Title

* 7. Please list all household members and their income:

Question Title

* 8. What is your  total household income?

Question Title

* 9. Is anyone in your household:

Question Title

* 10. Social Security Number

Question Title

* 11. Do you live on the Nez Perce Indian Reservation?

Question Title

* 12. Are you Homeless?

Question Title

* 13. Are you a Veteran?

Question Title

* 14. Tribal ID

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 15. Income Verification

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 16. Energy Bill

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
0 of 16 answered
 

T