Food Voucher Application

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Enterprise Rancheria

Estom Yumeka Maidu Tribe

Ph: (530) 532-9214

Fax: (530) 871-6655

2133 Monte Vista Ave.

Oroville, CA 95966

Email: donnar@enterpriserancheria.org

ENTERPRISE RANCHERIA

FOOD VOUCHER PROGRAM

The amount of assistance is $150.00 for households with No children under 18 years of age and

$300.00 for households with children under 18 years of age.

Household Information

Head of Household(Required)

Spouse

Address(Required)

Phone(Required)

Other Household Members

Name

Relationship

Age

Other Household Members

Name

Relationship

Age

Other Household Members

Name

Relationship

Age

Other Household Members

Name

Relationship

Age

Other Household Members

Name

Relationship

Age

I understand if I do not turn in all my grocery receipts within 30 days, I will be placed on the bad standing list for the Tribe and the amount of assistance will be taken out of any payments I receive from the Tribe or until it is paid in full.

Applicant Initials(Required)

Grocery Receipts or Supporting Documentation

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 64 MB.

Signature

Typed Signature(Required)

Signature Date(Required)

Food Voucher Application