Tunica Biloxi Tribal Member Catastrophic Relief Fund Request Form
The Tribal Council of the Tunica-Biloxi Tribe of Louisiana has established a Catastrophic
Fund (“the Fund”) for the purpose of providing assistance to Tribal Members who have
experienced a monetary loss because of an individual or family crisis. The catastrophic event or
crisis must be due to circumstances beyond the control of the applicant or a household member.
Payments from the Catastrophic Fund will be administered by the Tunica-Biloxi Community
Service Committee (CSC).

Eligibility of Funds is subject to (1) Completion of this Application, (2) Submission of all required documents and other information, (3) Compliance with the Program Guidelines, and (4) Review and approval by the Tunica-Biloxi Tribe’s Community Service Committee.

Remember, failure to submit all required documents will delay the application process. If you have any questions regarding the application feel free to call (318) 240-6436 or email TBCS@tunica.org.

Before filling out the form and uploading your documents please read the Application Eligibility and Guidelines document located here: http://www.tunicabiloxi.org/wp-content/uploads/2018/10/Catastrophic-Relief-Fund-Guidelines.pdf

Email address *
Please provide us with some information about you:
Tribal Roll Number *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Social Security Number *
Your answer
Marital Status *
Date of Birth *
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Please provide your current contact information below .
Current address on file with the Tribal Government *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
List all Tribal Members living in your household. Please list each family member's name and age:
Your answer
Please complete the following questions.
Qualifying Event for Which Funds are Requested (check one): *
If you selected "Other Catastrophic Event outside the control of applicant or member of household" above please describe the event:
Your answer
$ Amount Requested: *
Your answer
Provide Details of the Qualifying Event: *
Your answer
Date on which Qualifying Event occurred: *
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/
DD
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List all current sources of Household Income, including ANY disbursements from the Tribe: *
Your answer
NOTE: IN MOST CASES YOU WILL BE REQUIRED TO SUBMIT PROOF THAT YOU HAVE APPLIED FOR ASSISTANCE FROM ONE OR MORE OF THE BELOW SOURCES.
Check or List other resources your have received or for which you have applied: *
Required
List all checking, savings and investment accounts that are held in your name or the name of your spouse and the value of each such account:
Name(s) of Financial Institution(s) & the balance for each account:
Your answer
Supporting Documents
This application MUST be accompanied by supporting documentation. Please email your supporting documents to TBCS@tunica.org.

PLEASE ENSURE YOUR NAME AND TRIBAL ROLL NUMBER IS INCLUDED IN THE TITLE OF YOUR EMAIL and attached your supporting documents.

Supporting Documents include but are not limited to: Death Certificate, Invoices for Medical Costs, Receipts showing payments made to service providers or vendors, Rental or Lease Agreement

Monthly Expense Report
You MUST fill out a monthly expense report. To download the form go to http://www.tunicabiloxi.org/wp-content/uploads/2018/10/Expense-Report.pdf.

Please email your completed Monthly Expense Report to TBCS@tunica.org.

PLEASE ENSURE YOUR NAME AND TRIBAL ROLL NUMBER IS INCLUDED IN THE TITLE OF YOUR EMAIL and attached your report.

Please review the below statements and confirm that you understand and agree with each.
Confirmation of Information Provided
I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for denial of assistance present & future.
*
Required
Confirmation of Identification
I confirm that I am the person named above, that I am a member of the Tunica Biloxi Tribe of Louisiana and that I have not filled out this form on another's behalf. I understand that falsifying or failing to provide correct identification information on this form may result in my request not being processed.
*
Required
IN THE EVENT YOUR APPLICATION IS APPROVED, PAYMENTS WILL BE MADE DIRECTLY TO SERVICE PROVIDERS AND VENDORS, NOT TO THE INDIVIDUAL APPLICANT (EXCEPT IN CASES WHERE APPLICANT IS SEEKING REIMBURSEMENT FOR PAYMENTS HE/SHE HAS ALREADY MADE AND PROVIDES PROOF)
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