Follow the steps to fill out the application with ease.

1. Press the ‘Get Form’ button to access the application form and open it in the editor.
2. Begin by entering your name in the first name, middle initial, and last name fields. Ensure that the spelling is accurate, as this information is crucial for processing your application.
3. Fill in your date of birth in the designated field, following the required format.
4. Input your Social Security number correctly to verify your identity.
5. Enter your complete address, including city, state, and zip code, in the respective fields.
6. Indicate the date you are applying for assistance in the provided section.
7. Provide your telephone number, ensuring it is a number where you can be easily reached.
8. If applicable, enter your Leech Lake enrollment number in the specified field.
9. List all individuals residing in your household, detailing their last names, first names, relationships to you, dates of birth, and Social Security numbers. Use the back of the form if additional space is needed.
10. Document the total monthly income for all household members, specifying the source of income and including employers' phone numbers.
11. Clearly describe the type of assistance you are requesting and explain the reason for your request. Use the back of the form if necessary for additional details.
12. Indicate whether you are receiving Medical Assistance or are eligible for it, and whether you are a veteran. Select the appropriate options.
13. For each member of your household, list monthly expenses such as rent, mortgage, propane, electricity, food, and any other expenses. Provide the names and amounts accordingly.
14. Finally, review your application thoroughly to ensure all information is accurate. Sign and date the form to certify that the information provided is true and complete.
15. Once completed, save your changes, then download, print, or share the application as needed.

Don't wait; complete your application online today to access the assistance you need.