2025 Car Seat Application

TRANSPORTATION SAFETY PROGRAM
CAR SEAT PROGRAM GUIDELINES

The Car Seat Program is part of the Transportation Safety Program's Occupant Protection initiative to provide parents and caregivers car seats or booster seats as well as providing a hands-on educational guide in best practices for fitting and installation. Please review the information below regarding eligibility requirements:

Applicant must be a member of a federally recognized tribe and provide a copy of Tribal ID/CDIB of the enrolled tribal member (the child or parent/guardian)
Applicant must be able to provide a copy the child's birth certificate or guardianship papers.
Expecting mother's become eligible to receive an infant carrier no sooner than thirty (30) days from the due date and must provide documentation from your medical provider specifying the expected date of delivery.
Proof of assistance such as WIC, Child Care, or SNAP benefits is not mandatory but requested as it assists TSP when applying for grants that fund the Car Seat Program.
Most importantly THE CHILD MUST BE PRESENT for the appointment or outreach, the only exception is expecting mothers or an infant that has yet to be released from the hospital.
If the parent/guardian is unable to be present at the appointment/outreach, a parent/guardian may designate an Authorized Representative to attend in the parent/guardian's absence; however, the application must be signed by the parent/guardian prior to the scheduled appointment or outreach event.

Once eligibility has been determined, each applicant must receive guidance on the proper fitting of a car seat that fits the child and best practices on determining when a child needs to advance to the next size car seat. An example of when a child has exceeded the age, weight, or height of an Infant Carrier the child should then use a Rear-Facing Convertible Seat. Once guidance on proper fitting is completed, each applicant must receive instructions on how to install a car seat into a vehicle correctly.

In order to meet the needs of our Tribal community the Car Seat Program has updated its policies to allow for the applicants to obtain two car seats in a two year period per child in order to allow for parents/guardians to obtain a seat for themselves as well as a designated child care provider. One exception to obtaining a car seat before the two year period has passed is when it has been determined your child needs to advance to a car seat that fits better for safety purposes. At which time the parent/guardian will be required to complete an application and bring the child in for scheduled appointment or to an outreach event. The other exception to the two year period is if the car seat has been involved in a moderate or severe collision that impacts the integrity of the car seat is no longer deemed safe or guaranteed and must be replaced.

By signing this document you are agreeing that you have reviewed the Car Seat Program Guidelines and agree to cooperate with the policies of the program.

Applicant Signature*

Name*

ParentGuardian First NameParentGuardian Last Name

Mailing Address*

City*

State*

Zip*

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Who is the member of a federally recognized tribe?*

CHILD/CHILDREN INFORMATION, IF PREGNANT LIST DUE DATE*

	First Name	Last Name	DOB	AGE	Height	Weight
1
2
3

Please upload the Tribal ID/CDIB for the enrolled tribal member(s). If you are submitting Tribal ID/CDIB's for multiple children please ensure each child's enrollment information is uploaded: *

Please upload a copy of the child's birth certificate or guardianship papers, if the application is for multiple children please ensure each child's information is uploaded: *

Does the child or parent/guardian receive assistance? (WIC, SNAP, Soonercare, etc.)*

YesNo

If applicable please upload proof of assistance:

Is the requested child safety seat for the parent/guardian or childcare provider?*

Parent/GuardianChild Care Provider (i.e. Daycare, Spouse, Grandparent)

If Child Care Provider is selected above, please identify: First Name Last Name

Will the parent/guardian be present for the car seat fitting/installation appointment? (If no, anyone attending in the parent/guardian's place must be identified in the Authorized Representative Section below)*

YesNo

I, as the parent/guardian, hereby authorize First Name Last Name to act as my representative to receive services on behalf of the child/children identified.

ParentGuardian Signature

By signing this document I do attest that the information provided is accurate and true. Any personal information provided to the Transportation Safety Program will be maintained in complete confidentiality and is recorded for data and grant purposes only.

SIGNATURE*

CAR SEAT PROGRAM APPLICATION

CAR SEAT PROGRAM APPLICATION

AUTHORIZED REPRESENTATIVE STATEMENT