Adult Activities Support Services
FY 2024-2025 Application

Questions? Email the Program Coordinator, Nadine.Piatote@PuyallupTribe-nsn.gov or Call: 253-573-7829 | Fax: 253-680-5759

3009 E. Portland Avenue - Tacoma, WA 98404

The maximum Adult Activity Support Services Program assistance is $1,000 per year per adult Member.

Purpose

The intent of the Adult Activities Support Services Program is to aid Tribal member adults with monetary assistance for:

Participation in an organized adult sports team. ALL SPORTS TEAMS MUST HAVE 5 OR MORE PLAYERS TO BE ELIGIBLE FOR PAYMENT FOR TOURNAMENT FEE’S.
Other Activities: martial arts, health club membership, Native American arts registration fees only (As of June 2023, the cost of basket weaving kits will not be reimbursed. The program will no longer be paying for golf/country clubs).
Qualified exercise equipment ***** THIS IS A ONE TIME ONLY, NOT PER YEAR.

The program does not REIMBURSE for fees.

THIS IS FOR FY OCTOBER 2024-2025 ONLY.

This program does not reimburse for fees or cover travel or lodging.

Application Information

First Name:

Middle Initial:

Last Name:

Maiden Name:

Address:

City:

State:

Zip Code:

Phone Number:

Phone

Email Address:

Date of Birth:

mm/dd/yyyy

Age:

Enrollment #:

Organization/Vendor Information

Organized Adult Sports, Tournament, and other Activity: Marital Arts, Health Club Membership, and Qualified exercise equipment one time only.

Due to many personal training or fitness facilities (etc.) information out there, we are no longer accepting SSN#. The facilities/companies will need to have a company name with an Employer Identification Number (EIN#) that we will be sending the checks to.

It is the Applicants’ responsibility to get an invoice.

Name of Organization/Vendor:

Address of Organization/Vendor:

City:

State:

Zip Code:

Phone Number:

Phone

Email Address:

Fee Amount: (Indicate where appropriate).

Health Club Membership Fee:

Native American Arts and Crafts Fee:

Sports Tournament Fee:

Golf Tournament Fee:

Other Activities Fees:

Any amount over the $1,000 will be the responsibility of the applicant.

Please note: If the entry fee is over $1,000, the team will be responsible for the difference. When entering a team that includes non-Puyallup Tribal members, the entry fee will be divided by the total of individuals on the team. Non-Tribal members will be responsible for their share of the entry fee.

The program does not pay for online training.

CHECK PROCESS:

You must:

☛ Provide 2-week notice to process checks:

☛ Provide with AASS, entry flyer or tournament form that states the amount and date of the event.

☛ Program Coordinator will MAIL the check to the Organization/Vendors

REIMBURSEMENT OF FUNDS

If an adult relinquishes participation in any program and payment has been made to vendor, the Tribal member will either:

Seek reimbursement from vendor or
Reimburse the Tribe the amount of assistance issued to vendor.

If applicant does not seek reimbursement or payback the Tribe for non-participation after funds have been disbursed to vender, the applicant will not receive a credit on their Adult Activities Support Service Account.

Upload PDF Files:

Documents to upload: Event/tournament flyer (must indicate event name, date, and entry fee) Activity invoice Class Registration Form (provided by class instructor and MUST indicate acceptance in to class)

Drop your files here

Digital Signature

I certify

I certify that all the information provided herein is accurate and complete to the best of my knowledge. I authorize PTOI Adult Activities Support Services Program to verify all the information disclosed in this form. By signing this application, I agree to comply with the terms, policies and procedures.

I certify

Type your full name below for digital signature

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Adult Activities Support ServicesFY 2024-2025 Application