Emergency Assistance Request Contact InformationName*Please enter your first and last name First Last Address*Your complete mailing address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Enrollment Number*Your Snoqualmie Tribe enrollment numberPhone*A contact number you can be reached atEmail*An email address you can be contacted at Preferred Method of Communication*Please specify how you want to be contacted by Tribal Administration Phone E-mail Physical Mail Request DetailsIMPORTANT: A detailed description of a justified emergency must be provided. Applications submitted without a description of the emergency will be considered incomplete and will not be processed.Description of Emergency*Payment Type*Please choose the type of payment you are requestingChoose one$500 AdvanceReimbursementVendor Payment (W9 Needed)Amount Requested*Enter the benefit amount you are requestedSupporting DocumentationType of Emergency Documentation AttachedCheck all that apply Receipt Invoice Billing Statement W9 Notice Estimate Other File UploadUpload up to six supporting documents Drop files here or Select files Accepted file types: txt, doc, docx, pdf, jpg, png, bmp, gif, xls, xlsx, Max. file size: 256 MB, Max. files: 6. Acknowledgement*By signing and submitting this application, I certify that the information provided in this application, and any supporting documentation, is true, complete, and accurate to the best of my knowledge. I have reviewed a copy of the Snoqualmie Indian Tribe General Welfare for Emergency Assistance Program policy. I understand that providing false, misleading, or incomplete information may result in denial of my application, and/or termination of benefits if such information results in benefits to which I am not entitled. I acknowledge that the Tribal General Welfare Benefits provided under this Program may have tax or legal implications, and I understand that I am solely responsible for consulting with my own tax and/or legal advisor regarding any such consequences. I authorize the Housing Department to verify the information provided in this application and to contact other Tribal departments, programs, or third parties, including lenders, as necessary to determine my eligibility for the Program. I understand and agree that I am responsible for ensuring that any funds received under this Program are used solely for Eligible Expenses in accordance with the Program Policy. I further agree to repay any Tribal General Welfare Benefits that the Tribe determines were misused or improperly obtained, and I acknowledge that the Tribe may pursue any available remedies at law or in equity to recover such funds. I agree Anti-Spam Validation