Douglas Indian Association Tribal Member Info & COVID-19 Impact Questionnaire
MUST BE a Douglas Indian Association Enrolled Tribal Member 18 & Over
Email *
Are you an Enrolled Douglas Indian Association Tribal Member? (If we are not able to verify this info, you must provide proof of enrollment): *
First Name: *
Last Name: *
Maiden Name (if applicable):
Street Addres: *
City: *
State: *
Zip: *
Mailing Address (if different):
City:
State:
Zip:
Primary Phone: *
Additional Phone Info (Check all that apply. List a Secondary Number under "Other"): *
Required
Your Gender: *
Your Birth Date: *
MM
/
DD
/
YYYY
Are you the Head of Household? *
Please indicate your household size: *
How many household members are under 18 years of age? *
Are you a Shareholder of Sealaska Corp? *
Which Community Corporation(s), if any, are you a shareholder of? *
Required
Are you an enrolled member of Central Council of Tlingit & Haida Indian Tribes? *
Which Federally Recognized Tribe(s), if any, are you an enrolled member of? *
Required
Hereditary Information - Please list all Tribes, Ethnicities, & Other Info (i.e Clan & Moiety Information if known) *
COVID-19 Impact Inquiry
The Douglas Indian Association COVID-19 Tribal Response Team is collecting information to get a true understanding of how COVID-19 has impacted Tribal Members. This information is critical in assisting us to better serve you within our allowable limits.
Please describe in detail how COVID-19 has impacted you and your household? *
Please tell us what your most critical need(s) are (i.e. Employment, Housing, Utilities, Food, etc.): *
Other than the Federal Stimulus distribtuions, have you received any COVID-19 related assistance (Government, Tribal, or Other Organizations): *
Other (Please Explain):
Submit
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