Johnson O’Malley Program COVID 19 Application

Cheyenne and Arapaho Tribes Johnson O’Malley Program COVID 19 Application
School Year 2020-2021

Complete One Per Child

*For Eligible Johnson O’Malley Students Who Reside in Cheyenne and Arapaho Tribal Jurisdiction
Name *
DOB *
School Attending *
Grade *
T-Shirt Size *
Tribal Affiliation: *
Parent/Guardian Name *
Phone *
Address *
City/State/Zip *
Email Address: *
example@example.com
The Cheyenne and Arapaho Tribes is providing a one-time school supply assistance for your child or children. Due to the Covid 19 Pandemic. The Cheyenne and Arapaho Tribes Johnson O’Malley Program will not deliver school supplies or backpacks this year to your community. We will be providing school supply and backpack assistance for each child who is currently on our program. All “NEW” students will need to complete an application, and provide a legible copy of the child’s (CDIB Card) Certificate of Degree of Indian Blood. Please allow up to 2 weeks for processing your requests. If you have any questions you may call our office or email us at the numbers, and addresses below. We hope you and your family are keeping safe during this time, and we look forward in meeting the needs of your child or children.

THIS IS A ONE-TIME ASSISTANCE FOR THE 2020-2021 SCHOOL YEAR.
APPROVED AMOUNT:
APPROVED BY:
Date

Month Day Year
Date
Should be Empty:

Cheyenne and Arapaho Tribes Johnson O’Malley Program COVID 19 Application