Children Activities ApplicationFY 2022-2023

Children Activities Application

FY 2022-2023

Email: Nadine.Piatote@PuyallupTribe-nsn.gov

3009 E. Portland Avenue - Tacoma, WA 98404 Phone: (253) 573-7829 Fax: (253) 680-5759

Purpose

The intent of the Children’s Activities Program is to aid Tribal member students with monetary assistance for:

Purchasing of sports Equipment like (uniforms, cleats) and will be reimbursed only and receipts cannot Be older than 15 calendar days. Letter from School must identify the equipment.
entry into a youth Sports Tournament. ALL SPORTS TEAMS MUST HAVE 5 OR MORE PLAYERS TO BE ELIGIBLE FOR PAYMENT FOR TOURNAMENT FEES.
Extra Curricular Activities like music lessons, martial arts age limited, swimming, dance etc.
Monthly payment of band instrument.
Reimbursement of Drivers Education course.

The program does not REIMBURSE for fee.

Child Applicant Information

If guardian is not a Puyallup Tribal member, the guardian must provide documentation proving custodial parent of Tribal member child.

First Name:*

Middle Name:*

Last Name:*

Date of Birth:*

Age*

Enrollment #:*

Address:*

City:*

State:*

Zip Code:*

Phone Number:*

Parent's Email Address:*

CATEORIES: $1000.00 Limit per year.

Youth Sports Team/Equipment: participation in an organized youth sports team and purchasing sports equipment (with letter from school).

Youth Sport Team or Extra Curricular Activity: that special needs youth participate indirectly or directly in. Child applicant can qualify for the purchasing of specialized or adaptive equipment, uniforms or attire that may be required to participate in a selected program.

Extracurricular Activities: such as, swimming, dance, music lessons, or martial arts (age restrictions). NO PERSONAL TRAINER.

Band Instrument: monthly rental payment of band instrument for a year then the program will pay off the instrument to own.

Drivers Education: reimbursement of Drivers Education course when completed; and parents need to bring in the receipt and letter from school stating complete course.

Please Note: If you are applying for assistance for the Drivers Education Course, the cost of the course will be reimbursed to the applicant when the Program Coordinator receives a copy of certification of completion.

Please select Category *

It is applicant’s responsibility to obtain an invoice for all activities or a receipt for

reimbursement for Sports Equipment. The program coordinator will no longer accept

incomplete applications and it will not be processed.

Select or enter value

Organization Information

NAME OF ORGANIZATION, CONTACT PERSON, AND ADDRESS OF YOUTH ACTIVITIES:

Organized Youth Sports, Tournament, Sports Equipment, Purchasing of Specialize Equipment, Uniform, or Attire Necessary for Specialized Needs Youth to participate in Sports/Extra Curricular Activity either directly or indirectly, Extra Curricular Activity, Music Vendor, and

driver’s Education.

Name of Organization:*

Name of Contact Person:*

Organization Address:*

Organization City:*

Organization State:*

Organization Zip Code:*

Phone Number of Organization:*

Organization Email Address:*

OTHER INFORMATION

The Children’s Activity Program is funded by the Puyallup Tribe of Indians, therefore, at any time the amount of funding can either decrease or increase based on Funding Allocations.

WAIVERS

No waivers or exceptions to this policy will be allowed, including eligibility.

Check Process: You Must:

Provide a 1-week notice to process check
Provide with Application entry flyer or tournament form that state the amount, date of the event.
Program Coordinator will MAIL the check to the Organization/Vendors.

File Upload

File Upload:*

BASED ON THE CATEGORY SELECTED, THE APPLICANT MUST FILL OUT OR PROVIDE THE FOLLOWING INFORMATION:

Must be attending a credited school of learning (Preschool Elementary, Middle School or High School). 3 years and older in Pre-School need letter from Pre-School not Day Care. The program coordinator will call to verify.

Drag and drop files here or

FRAUD, MISREPRESENTATION, INCOMPLETE APPLICATIONS

If assistance is received and required receipts are not turned in within 15 calendar days, applicant will then be out of compliance with Children’s Activities policy and will need to reimburse the Puyallup Tribe for funds that are unaccounted for. The applicant will not be

eligible for further assistance until all funds are repaid to the Tribe. Withholding information, providing false information on application, actions that show intent to commit fraud against the Children’s Activities Program or submitting altered documents will result in immediate denial.

If the Program Coordinator determines based on reasonable grounds that the applicant has entered any false or intentionally misleading information or statements on any application submitted to Children’s Activities Program or to any other Puyallup Tribal assistance

program, the Program Coordinator, or a delegate, may suspend the applicant from receiving Children’s Activities Program funding for a period of one year. If it is determined the applicant has received assistance illegally or in violation of this policy, the Applicant will not be eligible for further assistance until all funds are repaid to Tribe. The

applicant must provide all necessary documents to complete a request. Incomplete applications will not be processed.

Digital Signature

I Certify that I understand that if I knowingly submit fraudulent information or do not use the funds for their intended purpose, I will not be eligible to receive funds under this program and may be subjected to prosecution in Tribal Court.*

Type your full name below for digital signature:*

Todays Date:*

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