Nebraska Minority Resource Center "Native American Relief Fund" Application form

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At times, due to emergencies, job loss or unexpected circumstances, people may find themselves in need of temporary help. We not only understand but consider it a part of our mission to help.

However, because we receive so many requests for help, we have developed several guidelines to help us determine when we can be of assistance. Of course, our first responsibility is to assist the members of Native American families. If and when we have additional resources, we may be able to help those who are not a part of a Native American Tribe or community, but this cannot be guaranteed. If we are not able to assist you, we would be glad to refer you to other agencies in the Panhandle area that may be able to provide assistance. In addition, we now require proof of residency and some sort of Identification, as we will only assist those who currently reside within the NE panhandle and Cherry County; and will allow only one request per household.

On a final note, please understand that we require a minimum of 7 business days to respond to your request. If this is an emergency, however and funding is available we may be able to respond sooner.

Highest priority will be given to those who:
1. In extreme need of emergency assistance
2. Are members of an American Indian Tribe. (This includes non-enrolled descendants with proof.)
3. Are living within the NE panhandle. (This includes Chery County)
4. Have not received financial assistance from NMRC in the past 3 months. (This allows us to assist others.)

Guidelines for financial assistance:
1. Only checks or vouchers will be used (sorry, no cash).
2. Financial assistance will only cover basic needs such as:
a. Food (Voucher will be provided)
b. Utilities such as water, electricity, natural gas (Limited Basis when funds are available)
c. Emergency Travel (travel within the region only)
3. Financial assistance will not cover items such as:
a. Telephone, internet or cable television
b. Car payment
c. Automobile insurance
d. Items not considered to be “essential needs”

If you meet the guidelines above, please fill out the attached request form. We will contact you once we have a chance to review your request.

First and Last Name *

Tribal Affiliation ( If Tribal Member) *

Phone number, Email or Contact Information *

Current Address *

City//Town *

Are you currently employed? *

Yes

Full-time

Part-time

Unemployed

Place of Employment. (If Employed) *

Name of Work place or Supervisor. *

Current Income *

$0 - $500 A month

$501 - $1000 A month

$1001 - $2000 A month

$2001 and Above..

No income

Marital Status *

Married

Single

Divorced

Widowed

Living Together

Number of children living with you under 18 *

If married or living together, does your spouse have a job? *

Yes

Maybe

Have you received financial assistance from NMRC in the past 3 months? *

Yes

Maybe

If yes, what was the need at that time? *

Have you received help from other organizations in the past 3 months *

Yes

If yes, above, what was the reason? and name of agency?

Explain why you need financial assistance: *

What created the need to arise? *

What do you need assistance with? *

Food

Gas

Other:

Required

Is there a deadline for this need to be met? If so, what is the deadline?

YYYY

Have you contacted family or friends for assistance? If so, how have they helped?

If you have any questions, you’re welcome to call us and leave a message at (308) 221-1203. Upon completing this form do you accept your submission as proof of requesting assistance? *

Yes

Submit

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