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 AfghanistanAlbaniaAlgeriaAmerican 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 RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussian FederationRwandaRéunionSaint 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 TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*A contact number you can be reached atEnrollment Number*Your Snoqualmie Tribe enrollment number EmailAn email address you can be contacted at, if available Contact Preference*Please select the method we use to contact youChoose OnePhysical MailPhoneEmailRequest DetailsJustification of Emergency* Financial Health Life Property Environment Payment Type*Please choose the type of payment you are requestingChoose one$500 AdvanceReimbursementVendor Payment (W9 Needed)Benefit Type*Please select the type of benefit requestedChoose OneFood/Clothing/GasCar Payment/Repair/TiresUtility Bill/FirewoodHousehold ApplianceHome RepairSecurity Deposit/Application FeeRent/Mortgage/Property TaxesMedical BillLodging: Work/Natural Disaster/MedicalFurniture/Household AccessoryCourt FeesMattressVeterinary BillMoving Truck/FeesOtherAmount Requested*Enter the benefit amount you are requested Comments/QuestionsSupporting DocumentationSupporting documentation can be scanned, faxed or mailed to the Snoqualmie Tribal Administration at: Attn: General Resources Department Mail: PO Box 969, Snoqualmie, WA 98065 Fax: (206) 202-4535 Email: GeneralResources@snoqualmietribe.usAcknowledgement*By checking the box you understand: I certify the information contained above is complete and accurate to the best of my knowledge. I understand that Tribe reserves the right to pursue any available remedies at law and/or equity to recover any misused funds. I agree that the Emergency Assistance Program may contact other tribal programs for pertinent information as it applies to this application. I understand that if I have requested an item that is considered a taxable expense I may be issued a 1099-MISC form at the end of the year. Additional program details can be located on the Emergency Assistance Application that can be found on the Snoqualmie Tribe’s website. I agree Anti-Spam Validation