2023 Lummi Nation Basic Needs Distribution Intake Form Question Title * 1. Please enter your full legal name Question Title * 2. Please enter your addressYour check will be mailed to the address you enter below Question Title * 3. Please enter your email address and phone number below Email Address Phone Number Question Title * 4. Please enter your enrollment number Question Title * 5. Please upload a copy of your Lummi Nation Tribal IDYour check will not be mailed if your Tribal ID is not uploaded PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your Lummi Nation Tribal IDYour check will not be mailed if your Tribal ID is not uploaded Question Title * 6. Please upload a picture of you holding your Lummi Nation Tribal IDYour check will not be mailed if you do not upload a picture of you holding your Tribal ID PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload a picture of you holding your Lummi Nation Tribal IDYour check will not be mailed if you do not upload a picture of you holding your Tribal ID Question Title * 7. Please enter your date of birth Date Date Question Title * 8. By typing your full legal name below you certify that you are an enrolled Lummi Nation tribal member and you hereby accept this basic needs distribution and will use the assistance to supplement your basic expenses such as paying for rent, utilities, mortgage payment, essential food or supplies, health care, etc. Done