Intake Form

Intake Form

Revised 6.10.2025
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
Enrollment # or Tribal Affiliation (if not Comanche)
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 information about the Comanche Nation or OutreachReferral & Resource Navigation (Tribal and External)Application Assistance (Tribal)News & EventsPeer AdvisingCareer Planning (Ex. exploration, resume/cover letter/portfolio review, or mock interviews)Community Pantry
Briefly explain what type of assistance you need (Example: car repairs or prescription costs):

Acknowledgement

By signing below, I confirm that I have read and understood the Intake Form guidelines and recognize that they may be updated periodically. I accept responsibility for staying informed of any changes. I understand that Outreach programs are not responsible for determining service eligibility, application requirements, processing, or distributing financial assistance—these responsibilities lie with the specific Comanche Nation department providing the service. I also certify that I have completed this form to the best of my ability and provided accurate information.
Signature*

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Contact Information