• Emergency Assistance Application

  • The Emergency Assistance program offers limited financial support to Yurok Tribal members experiencing household crises. Its purpose isto help stabilize tribal members during urgent times of need. Households mustmeet income guidelines at or below 150% of the federal poverty level.Assistance is available to those who have no other available resources to meettheir emergency needs. Services may include help with food, hygiene, clothing,utilities, housing, transportation, and health related needs.
  • Application Checklist
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  • Service Area:*
  • District:*
  • Format: (000) 000-0000.
  • Do you live on the Yurok Reservation?*
  • Is there an Elder (60+ years) in the Household?*
  • Rows
  • Is there a child 5 yrs or younger in the Household?*
  • Is there a person with a disability in the Household?*
  • Rows
  • Emergency Assistance (select one only): An Emergency is defined as a situation that presents animmediate threat to household’s stability, safety, or well-being and requirestimely intervention. Eligible emergency categories include, but are not limitedto, the following:*

  • Emergency Assistance Acknowledgements & Authorization to Release Information:

  • Date of Signature*
     - -
  • Date of Co-Applicant Signature
     - -
  • Should be Empty: