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Douglas Indian Association Tribal Member Info & COVID-19 Impact Questionnaire
MUST BE a Douglas Indian Association Enrolled Tribal Member 18 & Over
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Email
*
Your email
Are you an Enrolled Douglas Indian Association Tribal Member? (If we are not able to verify this info, you must provide proof of enrollment):
*
Choose
Yes
No
First Name:
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Your answer
Last Name:
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Your answer
Maiden Name (if applicable):
Your answer
Street Addres:
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Your answer
City:
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Your answer
State:
*
Your answer
Zip:
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Your answer
Mailing Address (if different):
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Primary Phone:
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Your answer
Additional Phone Info (Check all that apply. List a Secondary Number under "Other"):
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My primary phone is a cell phone
DIA may send me text messages
Other:
Required
Your Gender:
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Male
Female
Your Birth Date:
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MM
/
DD
/
YYYY
Are you the Head of Household?
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Yes
No
Please indicate your household size:
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Choose
1
2
3
4
5
6
7
8
9
10+
How many household members are under 18 years of age?
*
Choose
0
1
2
3
4
5
6
7
8
9+
Are you a Shareholder of Sealaska Corp?
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Yes
No
Which Community Corporation(s), if any, are you a shareholder of?
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Angoon - Kootznowoo Inc.
Craig - Shaan-Seet Inc.
Hoonah - Huna Totem Corp
Hydaburg - Haida Corp
Juneau - Goldbelt Inc.
Kake - Kake Tribal Corp
Kassan - Kavilco Inc.
Klawock - Klawock Heenya Corp
Klukwan - Klukwan Inc.
Saxman - Cape Fox Corp
Sitka - Shee Atika Inc.
Yakutat - Yak-tat Kwaan Inc.
None
Other:
Required
Are you an enrolled member of Central Council of Tlingit & Haida Indian Tribes?
*
Choose
Yes
No
Which Federally Recognized Tribe(s), if any, are you an enrolled member of?
*
Angoon - Angoon Community Association
Craig - Craig Tribal Association (previously listed as the Craig Community Association)
Douglas - Douglas Indian Association
Haines - Chilkoot Indian Association (Haines)
Hoonah - Hoonah Indian Association
Hydaburg - Hydaburg Cooperative Association
Kake - Organized Village of Kake
Kasaan - Organized Village of Kasaan
Ketchikan - Ketchikan Indian Community (previously listed as Ketchikan Indian Corp)
Klawock - Klawock Cooperative Association
Klukwan - Chilkat Indian Village (Klukwan)
Metlakatla - Metlakatla Indian Community, Annette Island Reserve
Petersburg - Petersburg Indian Association
Saxman - Organized Village of Saxman
Sitka - Sitka Tribe of Alaska
Skagway - Skagway Village
Wrangell - Wrangell Cooperative Association
Yakutat - Yakutat Tlingit Tribe
None
Other:
Required
Hereditary Information - Please list all Tribes, Ethnicities, & Other Info (i.e Clan & Moiety Information if known)
*
Your answer
COVID-19 Impact Inquiry
The Douglas Indian Association COVID-19 Tribal Response Team is collecting information to get a true understanding of how COVID-19 has impacted Tribal Members. This information is critical in assisting us to better serve you within our allowable limits.
Please describe in detail how COVID-19 has impacted you and your household?
*
Your answer
Please tell us what your most critical need(s) are (i.e. Employment, Housing, Utilities, Food, etc.):
*
Your answer
Other than the Federal Stimulus distribtuions, have you received any COVID-19 related assistance (Government, Tribal, or Other Organizations):
*
Your answer
Other (Please Explain):
Your answer
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