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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 below

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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 typing your full legal name below you certify that you are an enrolled Lummi Nation tribal member and you hereby accept this basic needs distribution and will use the assistance to supplement your basic expenses such as paying for rent, utilities, mortgage payment, essential food or supplies, health care, etc.

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