Confederated Salish and Kootenai Tribes

Virus8

CSKT COVID Relief2 Application

Request for Support

Good news Tribal Members, a second COVID Relief payment will be sent out soon. To receive payment, you will need to fill out a COVID Relief2 (COVID2) application. As before, each adult will have to fill out their own application. Minors will need a single adult to submit their application. Your payment will arrive the same way as your December per capita (if you get your per cap by mail, the COVID2 payment will arrive by mail. If you get your December per cap by direct deposit, your COVID2 payment will be a direct deposit.) If there are any questions, call our payment experts. If there are any questions, call our payment experts at 1-406-275-2733 or covidsupport@cskt.org.

Information

First Name:(*)

Your Name Required!

Middle :

Invalid Input

Last Name:(*)

Invalid Input

Your Email Address:

Invalid Input

Phone Number:

Invalid Input

Mailing Address

Street or PO Box:(*)

Invalid Input

City(*)

Your City Required!

State(*)

Your State Required!

Zip Code:(*)

Your Zip Code Required!

CSKT Enrollment Information

Are you an Enrolled Member of the Confederated Salish and Kootenai Tribes?(*)

YesNo

Select One!

CSKT Enrollment Number:

Enter up to 5 Digits!

(*)

Your CSKT Enrollment Number Required! Enter up to five digits of your enrollment number.

COVID-19 Hardship Information

Have you been directly impacted by a financial hardship such as loss of income or increased expenses due to COVID-19? (*)

YesNo

Invalid Input

If yes, do you need financial assistance to meet necessary expenses, such as rent, mortgage payments, utilities, food, or other emergency needs?

YesNo Invalid Input

CSKT Enrolled Children Information

Are you a parent , guardian or payee of an enrolled child? Select one.(*)

I'm a CSKT Member applying for CSKT Children.I'm NOT a CSKT member, but I'm applying for CSKT children.

I'm a CSKT Member applying w/o CSKT Children.

You must select one!

CSKT Enrolled Children Information

Total CSKT Enrolled Children Living in Household:

Invalid Input

If filling out on a mobile device works best in landscape mode.

Enter up to 5 Digits when adding children's enrollment numbers!

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Name:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

Child's Enrollment Number:

Invalid Input

By submitting this form I agree and hereby certify that I meet the CSKT COVID Relief2 application requirements for financial need, and the information submitted on this application is true and correct to the best of my knowledge. I also authorize CSKT to share this information with its Enrollment Office to verify my tribal enrollment status and/or the tribal enrollment status of the minor(s) in my custody and care. If applicable, I authorize CSKT to share this information with its Social Services Department to verify the tribal member minor(s) in my custody and care.

Captcha(*)

Invalid Input