Sweetgrass AG Benefits Form

Disclaimer: I hereby certify that the information provided in this form is complete, true, and correct. By submitting personal information, I consent to its collection, storage, and use as part of Sweetgrass First Nation's Agriculture Benefits engagement process. Furthermore, I hereby release and hold harmless Sweetgrass First Nation and its agents from any liability associated with inaccurate information provided herein or data breaches.

Sweetgrass First Nation is committed to safeguarding your data and will only use it for the purposes outlined at the time of collection. Data security is a priority and any information you share is held in strict confidence by Sweetgrass First Nation and its data collection team. Preferred method of information gathering is online and if you have any concerns, or require assistance please phone or text the Agriculture Benefits representative at 306-480-4866 or email agbenefits@sweetgrassfirstnation.ca to discuss alternatives.
General Information

This information can better assist Sweetgrass First Nation membership with future communication and strategic planning. Please note: fields with the little red stars are required fields to fill out.
Legal Name*
Additional Names (Optional)
Birth Date*

DayMonthYear
I live On my Reserve*

YesNo
I live on another Reserve

YesNo, I live in a municipality
Home Address *

Street Address

Street Address Line 2

CityProvince / State

Postal / Zip Code
Mailing Address (If same leave blank)

Street Address

Street Address Line 2

CityProvince / State

Postal / Zip Code
Status Number*
Email
example@example.com
Mobile Phone*
Please enter a valid phone number.
Alternate Number
Please enter a valid phone number.
Employment Status
Gender
Sweetgrass First Nation recognizes gender identity is complex and deeply personal and respectfully offers options for both traditional and contemporary understandings of gender.
Status Card- Upload here

Upload a file from your computer or simply click here while using a phone or tablet and take a picture or upload from photo gallery
Cancelof
Drivers License- Not required but if you do not have a copy of your Status Card

Upload a file from your computer or simply click here while using a phone or tablet and take a picture or upload from photo gallery
Cancelof
Dependant Information

This information can better assist Sweetgrass First Nation membership with future communication and strategic planning.
Number of Dependants under 18yrs
Dependent(s) Under 18yrs
I would like to speak to a representative of Sweetgrass First Nation about a member who requires extra assistance or support services (e.g. an individual with a cognitive disability or incarcerated

YesNo, I will reach out
Member Registry Information Update

Updated member information is extremely important in providing quality services for all Sweetgrass First Nation members. Sweetgrass First Nation would like to utilize non-banking information provided in this form to update the Sweetgrass member registry software.
Use my non-banking information to update Sweetgrass First Nation Member Registry*

YesNo
Banking Information

Unless otherwise permitted, all records of banking information will be permanently deleted once Sweetgrass First Nation members have received the Agriculture Benefit distribution payment resulting from the Specific Claims Settlement.
Please delete my banking information after I have received the Agriculture Benefit distribution*

Yes, please delete my banking informationNo, please keep my banking information on file for any further Sweetgrass First Nation member distributions or payments
Direct Deposit form or void cheque

This form is used to confirm the applicant is the owner of the bank account and must contain applicants name and banking information. I.e, direct deposit form from your bank or a void cheque.
I have already submitted my direct deposit information to Sweetgrass First Nation and i want to use what is on file*

YesNo
If Selected No Please Submit A Direct Deposit Form OR Void Cheque- Upload here

You can visit your bank for a copy or download a copy using online banking. Once you have a copy, upload a file from your computer or simply click here while using a phone or tablet and take a picture or upload a photo from you photo gallery
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Should be Empty:

General Information

Dependant Information

Member Registry Information Update

Banking Information

Direct Deposit form or void cheque