General Welfare Assistance Request Form

Tribal Member Name(Required)

Tribal ID #(Required)

Date of Birth(Required)

Physical Address(Required)

Mailing Address

Contact Number(Required)

Please explain what you are requesting assistance for: (Please be specific)(Required)

The General Welfare Assistance funds are for an emergency circumstance that exhibits a clear health and/or safety threat. Please explain how your circumstance meets this criterion(Required)

The Cahuilla Band of Indians requires the submission of three bids to complete your request. Please attach and list the bids below:

Bidder Name or Company

Total $ Amount:

Bidder Name or Company

Total $ Amount:

Bidder Name or Company

Total $ Amount:

Cahuilla Band of Indians use ONLY: (below the line)

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Request Fulfilled (Y/N)

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Selected Bidder

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Amount Approved

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Tribal Council Approval (please sign)

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Date

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Motion #

Phone

This field is for validation purposes and should be left unchanged.

Contact Information

Cahuilla Band of Indians
52701 US Hwy 371
Anza, CA 92539

Phone | (951) 763-5549
Fax | (951) 763-2808

General Welfare Assistance Request Form

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