General Assistance Application

List of Required Documents

  • Complete GA Application
    Application needs to be signed and dated by applicant and CTC

  • Complete Individual Self Sufficiency Plan (ISP)  

  • Eligibility Review Form

Copies of the Following:

  • Proof of current bills for deductions and Residency
  • Tribal ID or Certification of Indian Blood
  • Photo ID
  • Social Security Cart if SSN is not listed on application
  • Bank Statement for the month that the application was submitted
  • Proof of ALL income for the month the application is submitted
    • Examples
      • Employment Wages
      • Child Support
      • Unemployment Income
      • Self-Employment Income
      • Tax Returns

Cheesh’na Tribal Council

HC01 Box 217

Gakona, AK 99586

907-822-3503

Application for Welfare Assistance

 
**Incomplete Applications Will NOT be Processed**


List ALL MEMBERS of the Household

 

Person 1


Person 2


Person 3


Person 4


Person 5


Person 6


Person 7


Person 8


Members of Household with Physical or Mental Handicaps

 

Person 1


Person 2


Please list and format accordingly: "Name, Native Corporation, Shares Owned" for each member.

Record of Income and Resources

 

If yes, list the name of household member(s), source of income, and amounts below.

**You are required to report income received from the following**

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Monthly Shelter Costs

 

**Provide all expenses for the current month**

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READ BEFORE SIGNING

 

I/We apply for financial assistance/services for the listed members of my (our) household who are in need. I/We have received a copy of and have had explained to us and understand the provisions of Federal Law governing fraud.

Initials of Applicant
Initials of Applicant