Creek Nation Application Form – Fill Out and Use This PDF

The Creek Nation Application Form is a comprehensive document used by the Muscogee (Creek) Nation's Social Services Department to collect essential information from individuals and families seeking assistance. It covers areas such as household information, contact details, housing situation, household composition, income verification, employment/education status, specific needs for assistance, and other sensitive data to ensure the appropriate support is offered. If you are looking to apply for services from the Muscogee (Creek) Nation, ensure to fill out this form accurately. Click the button below to start your application.

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Creek Nation Application Form PDF Details

Applying for assistance within the Muscogee (Creek) Nation involves a comprehensive process that is initiated by completing the Creek Nation Application form available through the Social Services Department. This form is designed to collect detailed information from applicants across several crucial areas such as household composition, contact specifics, housing situation, employment and educational status, income verification, and the type and rationale for assistance requested. Whether individuals are seeking support due to facing a natural disaster, requiring emergency assistance for housing or utilities, or inquiring about medical travel support, the application ensures a structured approach to identifying and meeting their needs. Additionally, it probes into whether the household is receiving any form of social security, disability, retirement pensions, SNAP, or commodities to better understand their financial situation. Other segments delve into any potential conflicts of interest and duplicate services to maintain transparency and fairness in the allocation of resources. Applicants must also disclose their relationship status including if they or their spouse/significant other is Indigenous and list their tribal affiliation, enhancing the cultural and societal context of the application. Through this form, the Muscogee (Creek) Nation Social Services aims to thoroughly assess each application to provide tailored support to its community members.

Question	Answer
Form Name	Creek Nation Application Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	muscogee creek nation social services phone number, creek nation hardship, creek nation clothing application 2018, oklahoma creek nation social services

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0uscogee (Creek) 1ation

$PP#:__________________

Social SerYices Department

Social SerYices Office

$pplication

SECTIO1 1. HOUSEHOLD I1FOR0$TIO1

$. Head of Household 1ame: ________________________________________________

0aiden 1ame: ___________________

Is the Head of Household Indian"

<es

If \es, please list Tribe/Roll#: ____________________________

0arital Status:

Single

In Relationship

0arried

Separated

DiYorced

:idoZ/er

B. Spouse/Significant Other 1ame (if applicable): ________________________________

0aiden 1ame: ___________________

Is the Spouse/Significant Other Indian"

<es

1o If \es, please list Tribe/Roll#: ____________________________

C. Is the Head of Household non-Indian and appl\ing on behalf of an Indian minor"

<es

0inor 1ame: _____________________________________

DOB: __________________ SS1#: ______________________

Please check if the Head of Household or Spouse/Significant Other is:

Legal Parent

Legal Guardian

Foster Parent

Other:_______________________________________________________________________

D. $re \ou or an\ household member receiYing an\ of the folloZing" (Please check all that appl\.)

Social Securit\ $dministration (SS$)

Supplemental Securit\ Income (SSI)

Social Securit\ Disabilit\ (SSDI)

Retirement Pension

E. $re \ou or an\ household member a 9eteran"

<es

$re \ou receiYing disabilit\"

<es

F. Do \ou or an\ of the household members receiYe S1$P or Commodities"

<es

S1$P $mount ReceiYed __________

EffectiYe Dates: ______________________________________________

Commodities EffectiYe Dates: _______________________________________________

G. Do \ou or an\ household member receiYe Temporar\ $ssistance for 1eed\ Families (T$1F)"

<es HoZ much a month" ____________

H. $re \ou appl\ing for serYices due to a Child :elfare case"

<es

Through Zhich office"

DHS

Tribal

Case :orker 1ame: _____________________________________ Phone 1umber: ______________________________

I. $re \ou in an abusiYe relationship"

<es

0C1 Famil\ 9iolence PreYention Program

$re \ou being stalked"

<es

918-732-7979

HaYe \ou been sexuall\ assaulted"

<es

If \ou ansZered \es, please call to speak Zith an adYocate or ask

the 0C1 Social SerYices staff to assist \ou.

Do \ou feel unsafe in \our home"

<es

J. $re \ou or an\ of \our household members a member of a 0uscogee (Creek) 1ation Indian Communit\ Center or Tribal ToZn"

<es	1o	If \es, Zhich Communit\ Center" __________________________________________________

<es	1o	If \es, Zhich Tribal ToZn"________________________________________________________

Page 1 of 6

Revised 1/2015 ss

SECTIO1 2. CO1T$CT I1FOR0$TIO1

$. $ddress: _______________________________________________________________________________________________

Count\: _________________ Cit\: ____________________________________

Phone: _________________________	0essage Phone: ___________________
Best Za\ to contact (check all that appl\):		Phone Call	Text
Best Za\ to contact (check all that appl\):		Phone Call	Text

State: ____________ Zip: ___________

Email: ____________________________

0ail Letter		Email

		SECTIO1 3. HOUSI1G SITU$TIO1

$.	Renter/$mount __________/month		HomeoZner/0ortgage $mount __________/month

Homeless/Sta\ing Zith famil\ or friends. Please list the person \ou are sta\ing Zith:______________________________

Other: ___________________________________________________________________________________________

___________________________________________________________________________________________

B.:hat utilities do \ou pa\" (necessit\ utilities onl\)

Electric

Gas

:ater

Propane

Other: __________________________________

SECTIO1 4. HOUSEHOLD CO0POSITIO1

				REL$TIO1 TO
				HE$D OF
HOUSEHOLD 0E0BER 1$0E	DOB	SS1#	TRIBE/ROLL#	HOUSEHOLD

10.

SECTIO1 5. I1CO0E 9ERIFIC$TIO1

PLE$SE LIST $LL I1CO0E FOR THE HOUSEHOLD

E$R1ED $1D U1E$R1ED I1CO0E

(Emplo\ment, Unemplo\ment Benefits, Child Support, T$1F, SS$, SSI, SSDI, 9$, Retirement, Ro\alties, etc.)

HOUSEHOLD 0E0BER 1$0E	I1CO0E		HO: OFTE1
HOUSEHOLD 0E0BER 1$0E	(GROSS $0OU1T)		HO: OFTE1
	(GROSS $0OU1T)
1.	D$IL<	:EE.L<	BI-:EE.L<	0O1THL<	SE0I 0O1THL<
2.	D$IL<	:EE.L<	BI-:EE.L<	0O1THL<	SE0I 0O1THL<
3.	D$IL<	:EE.L<	BI-:EE.L<	0O1THL<	SE0I 0O1THL<
4.	D$IL<	:EE.L<	BI-:EE.L<	0O1THL<	SE0I 0O1THL<
5.	D$IL<	:EE.L<	BI-:EE.L<	0O1THL<	SE0I 0O1THL<
6.	D$IL<	:EE.L<	BI-:EE.L<	0O1THL<	SE0I 0O1THL<

**********************************************OFFICE USE O1L<*********************************************

TOT$L GROSS 0O1THL< I1CO0E:	Does applicant haYe the abilit\ to maintain"	<es	1o
TOT$L GROSS 0O1THL< I1CO0E:	Does applicant haYe the abilit\ to maintain"	<es	1o
TOT$L GROSS $11U$L I1CO0E:	$mount ______________
TOT$L GROSS $11U$L I1CO0E:	$mount ______________

Page 2 of 6

Revised 1/2015 ss

Creek Nation Application Form – Fill Out and Use This PDF

Creek Nation Application Form PDF Details

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