Before you fill out please read the following TERMS AND CONDITIONS:

1. Must be a member of Salt River First Nation 195

2. Must be in self Isolation for a minimum of 14 days

3. Must be unemployed and/or last resort for help

4. One Per Household

5. High risk categories get priority:  Compromised immune system,  Elder, Parent with dependent(s), Cannot afford basic needs, Single with limited funds, Guardian with child member, Disabled, Injured (immobile) , Not working and no help given

6. BANKING INFORMATION MUST BE SENT TO FINANCE.OFFICER.SRFN@NORTHWESTEL.NET

7.  DO NOT GIVE ANY BANKING INFORMATION TO ANYONE OVER THE PHONE- THANK YOU

8. I hereby state that I understand, that this one-time funding for an emergency with the COVID 19; This money is based on a budgeted amount and may be expended by the time of this application; Everything I wrote is true and to the best of my knowledge is correct; If you are uncomfortable sending private information digitally please call 867-872-2986 and we will send you a paper copy via regular postal mail.