Eastern Shoshone Tribe COVID-19 Assistance Program
Eastern Shoshone Business Council has APPROVED a Second (2nd) COVID-19 monetary assistance to be disbursed to all enrolled adult Eastern Shoshone Tribal members. In order to receive COVID-19 monetary assistance from Eastern Shoshone Tribe through the Cares Act, this form needs to be filled out in its entirely
Adult Applicants ONLY
Applicants turning 18 y/o up to September 1, 2020 are eligible
First Name *
Middle Initial
Last Name [Include Maiden Name (If Applicable)] *
Sufix (Sr. Jr. etc)
Date of Birth *
Eastern Shoshone Tribal Enrollment Number [282 U0] Not Required
Mailing Address (Where the disbursement check will be mailed) *
City *
State *
Zip Code *
Contact Phone # *
Never submit passwords through Google Forms.
This form was created inside of Eastern Shoshone Credit Program. Report Abuse