Local Government Assistance Request Form

"*" indicates required fields

NAME OF ORGANIZATION*

STATUS OF ORGANIZATION (please provide Tax Id #)*

ADDRESS*

PHONE*

FAX

CONTACT NAME*

TITLE*

Tribal ID #*

PHONE OF CONTACT*

EMAIL*

TITLE OF EVENT*

EVENT DATE*

DATE TO RECEIVE FUNDS BY

PLEASE EXPLAIN THE PURPOSE OF YOUR REQUEST AND WHO IT WILL BENEFIT*

(Please attach any donation request letters that you may have on your organizations letterhead)

WHAT IS THE TOTAL AMOUNT NEEDED TO FULFILL YOUR REQUEST?*

(Please attach any donation request letters that you may have on your organizations letterhead)

What amount are you seeking from the Cahuilla Band of Indians Aid to Local Government?

If request is granted, check can be made payable to (please provide address):

Name of Organization*

Memo

Address*

Name of Requestor*

Date submitted

For Cahuilla Band of Indians use only

Staff:

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Received By

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Date

Council:

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Request Approved (Y/N)

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Amount Approved

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Comments or Questions

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Signature

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Date

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Comments

Phone

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

About

About

Enterprises

Tribal Government

Economic Development Corporation (E.D.C)

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Fire Department

Human Resources

Justice Department

Planning Department

Contact Information

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

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

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