TRIBAL PROGRAM NEWS
Computer Requests
Eligible Forms of Documentation
Unacceptable forms of verification:
Address Verification
For tribal member applicants and
applicants for non-tribal custodial
parents addresses, the following types
of documentation are acceptable:
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Telephone bill
Water/sewer bill
Cellular telephone bill
Natural gas bill
Garbage collection bill (regular
weekly service)
Property tax statement
Monthly mortgage statement
Formal rental agreements from
outside parties or agencies
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Custody Verification
For non-tribal custodial parents, the
following types of documentation are
acceptable. These verification(s) must
accompany the application form.
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All documentation must be in the
applicant’s name as it appears on the
tribal roll and list the street address
(not just mailing address) where service
is provided.
Notes, rental agreements, or letters
from family, friends, or co
habitants in the residence
Medical bills
Driver’s licenses
Utility bills in someone else’s name
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Divorce decree awarding custody
to applicant parent
Adoption or state/tribal welfare
placement records awarding
custody to applicant parent
In the absence of either of the
above, copies of birth certificates
listing the tribal parent applicant
Computer Application Request Form
Deadline for applications is
4:30 p.m. on Jan. 15,2004. Households
eligible to apply include:
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The burden of proof is on the
applicant. Applicant and previous
recipient must provide verifica
tion of their current residence.
Any tribal household that has not
previously received a computer
Any non-tribal household that has
custody of tribal children and has
not previously received a computer
Any household with duplicate
addresses that can provide proof
that the person/household that
previously received a computer is
no longer part of their household.
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Non-Tribal Custodial Parent Application on Behalf
of Enrolled Siletz Tribal Child(ren)
Computer Application Request Form
(One per household/address)
Parent’s Name:_________________________________________________________
Enrolled Child(ren) Name(s):____________________________________________
(One per household/address)
Applicant Name:_______________________________________________________
Roll #:___________________________
Social Security #:--------------------------
Street Address:_________________________________________________________
Mailing Address:_______________________________________________________
City/State/ZIP:_________________________________________________________
Telephone #:______________________
I am requesting a computer for my household. I understand that it is a taxable
donation and that I am responsible for payment of any taxes due on the value of
the computer.
Signature:_____________________________________
Date:_______________
What level of computer knowledge does your household possess?
None Basic Intermediate
Advanced
Would you need assistance to set up the computer?
If yes, would the assistance be:
in home
No
Yes
by phone
Would you require training to operate the computer?
No
Yes
Please complete and return by 4:30 p.m. on Jan. 15, 2004. Please make
sure you enclose verification of your physical address in the applicant’s name as
it appears on the tribal rolls. Verification may include an electric bill, phone bill,
other utility bill, or property tax statement that lists the applicant’s name and
physical address. Applications without this verification or received after the
deadline will not be considered. If you have any questions, please leave a message
-at 541-444-8305 or 1-800-922-1399, ext. 305, and we will return your call.
Do not fax your application. Original signatures are required. Return
completed applications to Confederated Tribes of Siletz Indians of Oregon,
Attn: Computer Applications, P.O. Box 549, Siletz, OR 97380-0549.
Roll #:________________________________________________________________
Street Address:______ ___________________________________________________
Mailing Address:_______________ ______________________________________ _
City/State/ZIP:___________________ _____________________________________
Telephone #:Parent’s Soc. Security #:
I am requesting a computer for my enrolled Siletz tribal child(ren). I understand
that it is a taxable donation and that I am responsible for payment of any taxes
due on the value of the computer.
Date:_______________
Signature:-------------------------------------------------------
What level of computer knowledge does your household possess?
None Basic Intermediate
Advanced
Would you need assistance to set up the computer?
If yes, would the assistance be:
in home
No
Yes
by phone
Would you require training to operate the computer?
No
Yes
Please complete and return by 4:30 p.m. on Jan. 15, 2004. Please make
sure you enclose verification of your physical address in the applicant’s name.
Verification may include an electric bill, phone bill, other utility bill, property tax
statement, or other verification that lists the applicant’s name and physical address.
Also, verification of custody of the applicant parent through birth certificates,
divorce decrees, or other documentation granting custody to the parent applicant.
Applications without this verification or received after the deadline, will not be
considered. If you have any questions, please leave a message at
541-444-8305 or 1-800-922-1399, ext. 305, and we will return your call.
Do not fax your application. Original signatures are required. Return
completed applications to Confederated Tribes of Siletz Indians of Oregon,
Attn: Computer Applications, P.O. Box 549, Siletz, OR 97380-0549.
January 2004 □
Siletz News
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