Enrollment/ Per-Capita Address Update Form

Birth Date(*)

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Enrollment Number:(*)

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Make sure your first and last name is as it shows on your Tribal ID / Records.

First Name:(*)

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Middle Initial:(*)

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Last Name(*)

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Email:(*)

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If you have changed your last name please provide below.

Last Name (if recently changed):

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List of minor children living within your home:

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Please provide your mailing address change below.

New Address:(*)

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City:(*)

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State:(*)

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Zip Code:(*)

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Please provide your physical address:

Physical Address:(*)

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City:(*)

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State:(*)

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Zip Code:(*)

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If you live on the Flathead Indian Reservation please include your tribal voting district by choosing one of the listing in the drop-down.

Voting District(*)

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If you receive Child Support or are paying Child Support it is up to you to make sure you send your changes to the Child Support Enforcement Office as well.

Vendor Address would need to be changed if you receive child support:(*)

YESNO

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by submitting this form I acknowledge that the above information is true and correct and take full responsibility for any misinformation.

Enrollment/PerCapita Address Change Form