Cultural Activities Request Form

Under the Individual Cultural Activity program, Tribal members may apply for a two hundred dollar ($200.00) grant to support their cultural activities. The intent of this program is to provide Tribal members with the financial support to purchase materials/supplies for making regalia of their choice.

"*" indicates required fields

Name*

First Last

Date of Birth*

Roll Number*

In care of:

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Address (If different than mailing)

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email*

Proposed Cultural Project Description*

Please describe your project.

Proposed cultural project cost estimate:*

Note: the maximum amount funded is $200.00. To add another item to the list, click the plus button on the right.

Vendor

Items

Estimated Cost

Total Estimated Cost*

Have you ever recieved a cultural activities grant?*

Yes

Did you complete a report on the fund awarded to you previously?*

Yes

Please note: Per Cultural Activities guidelines you must submit a report on prior grants prior to receiving a new grant.

Will you need assistance in expending your cultural activities fund?*

Yes

Will you need assistance in completing your project?*

Yes

If so, who will be assisting you?*

Signature*

Date*

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Name

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Cultural Activities Request Form

Cultural Activities Request Form

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