Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your client name and the date on the application. This identifies your application clearly.
3. Fill in your telephone number and message phone, if applicable. This information will be used for contact purposes.
4. Indicate your district by checking the appropriate box (South, East, North, Orick, Requa, Pecwan, Weitchpec) to show your community affiliation.
5. List all household members along with their relationship to you, dates of birth, ages, and Tribal Roll numbers if applicable. This information is essential for the verification process.
6. Detail the monthly income of all household members by entering the source, names, and amounts. Be thorough to ensure accurate processing.
7. In the space provided, describe your emergency situation clearly and concisely. This section is crucial for understanding your need for assistance.
8. Review and sign the certification section. By doing so, you confirm that all information provided is truthful and understand the consequences of any misrepresentation.
9. If applicable, fill out the verification of unemployment/no income section for each household member 18 years or older who is unemployed.
10. For the authorization to release information section, indicate any organizations or individuals authorized to receive or release information concerning your case.
11. Select the type of assistance you are applying for by checking the appropriate box (e.g., Emergency Medical Transportation, Rent/Mortgage). Be sure to include all necessary details as required.
12. Once all sections are completed, review your application for accuracy. Save any changes made, and consider downloading or printing a copy for your records.

Complete your Emergency Assistance Application online today to ensure you receive the support you need.