Transportation Assistance Program Request

 

Note: All fields marked with a red asterisk (*) are required.

  • Contact Information

  • Please enter your first and last name
  • Your complete mailing address
  • A contact number you can be reached at
  • Your Snoqualmie Tribe enrollment number
  • An email address you can be contacted at, if available
  • Please select the method we use to contact you

  • Request Details

  • MM slash DD slash YYYY
  • Please choose which clinic your vaccination appointment is with.
  • Please select which transportation reimbursement you are requesting.

  • By checking the box you understand: t is the intent of Tribal Council that the Program be funded from the Tribe’s general fund, and that payments issued under the Program will not be subject to state or federal taxation and will not reduce fixed income or other benefits of the recipients. However, recipients should consult with their own tax and/or legal professionals to determine actual tax and benefit consequences, and recommended uses. The Program is intended as a social welfare program to provide for the general welfare of Snoqualmie tribal members. The Policy for Transportation Assistance Program provides guidelines and procedures for usage and limits on spending to promote the general welfare of tribal members. The recipient understands a Form 1099-MISC may be issued to the recipient if the Tribe deems the funds to have been misused. This benefit may not be offered for all meetings and events. The approval of this funding is at Tribal Council discretion. The recipient understands that the Tribe will verify proof of attendance at their appointment through an internal check of the Tribe’s attendance logs. By signing, I certify the information contained in this application is complete and accurate to the best of my knowledge. I agree that the Transportation Assistance Program may contact other Tribal programs for pertinent information as it applies to this Request.

Purpose

The purpose of the Transportation Assistance Program (“Program”) is to provide limited financial assistance to offset the transportation costs (“Assistance”) of adult enrolled Tribal Members traveling to attend the Snoqualmie Tribal Vaccine Clinic or a vaccine appointment hosted by our community partner Cowlitz Tribe at the Tukwila clinic, as by Tribal Council.

The Snoqualmie Indian Tribe has established the following criteria with the intent to ensure the Transportation Assistance Program functions in accordance with the Tribal General Welfare Policy.

Program benefits are subject to change at any time based on the availability of funds, as may be determined by resolution of the Tribal Council of the Snoqualmie Indian Tribe.

Eligibility

Adult enrolled Snoqualmie Tribal Members who meet the requirements of the Transportation Assistance Program Policy (“Policy”) and request assistance for, and attend, an approved vaccine appointment at the Snoqualmie Casino or our community partner clinic in Tukwila are eligible to receive Assistance. The amounts provided for assistance are a flat rate for gas or airfare as listed below. Assistance is only available as a reimbursement once you have attended an eligible clinic.


Limits on Distribution

  • This Form must be returned to the General Resources Department within 60 days of you appointment to be eligible for a reimbursement.
  • Assistance is available one per Tribal Member per vaccine appointment (Moderna vaccinations will be eligible to apply for assistance per trip for a total of two benefits).
  • The Tribal Member receiving Assistance must check in at the appointment as proof of attendance in order to receive the benefit. Attendance will be checked through an internal process.
  • The purposes of this Assistance is to assist with the cost of transportation.