Intake Form

Intake Form

Revised 2.2.2026
All Comanche Nation Dallas Outreach (CNDO) services provide tribal members with essential assistance, communication, and resources. An Intake Form is required to verify eligibility and maintain service records. Please follow the guidelines below to access these services.

Contact Information
Please select applicant type:*

New (did NOT submit a form this fiscal year)Returning (did submit a form this fiscal year but need help with a different service)
New Applicants: Please complete this entire section.

Returning Applicants: Please provide your full name then proceed to next section.
Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Tribal Affiliation/Enrollment #
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Preferred Method of Contact*

CallTextEmail
Address

Street Address

Street Address Line 2

CityState

Zip Code
Optional: Upload proof of tribal enrollment (CDIB card or verification letter)

Cancelof

Assistance Request
Please select which services you need assistance with or would like to learn more about:*

General Outreach InformationCase Management (Referrals & Resource Navigation)Community Engagement (Events/Activities)Professional Support (Career Planning)Pantry
Briefly explain what type of assistance is needed (e.g., car repairs or utilities):
Should be Empty:

Contact Information