Sapotaweyak Cree Nation COVID-19 Off Reserve Emergency Support Program

Sapotaweyak Cree Nation is Committed to Suppoting all its band members as we collectively face this global
pandemic. We know and understand there are band members experiencing chanllenging circumstances durning this
pandemic that require additional support and/or assistance.

In order to potential assit off-reserve band members. SCN has set up a COVID 19 Emergency support program.
durning this time, this Off reserve Emergency support Program is intended to provide one time financial
assistanceto off reseserve band members that are unable to get assistance from other programs and/or services.

Please determine if you are eligible to apply for this Emergency Support Program by reviewing the eligibility
criteria. SCN will not be able to support all the applicants, priorty will be given to those member deemed to be in most need.

You Can Apply if:
You are a registered band member living off reserve
you are the age of majority (18)
You are not eligible for other kinds of government programs and support ie. Canada Emergency Response Benefits
You are a post Secondary that still requires living support
You are normally employed full-time, but your hours have been cut or lowered then 20 hours per week
You are an Elder (Senior 65 years of age or older) that requires additional support for day to day living
you have a disability that requires additional support for day to day living
You are a parent of a child with a disability that requires additional suport
If you meet the criteria outlined, please complete the application

Please note one application per house hold. Please submit a online application if you cannot, please contact 1-204-587-2012 for assistance.
Thank you for taking the time to fill out this needs assessment and support services survey.
Please be advised that it may take a navigator up to 72 hours to make contact.
If you are experiencing and emergency, Please contact your nearest emergency Provider.

Printable PDF form for fax or email

SCN Urban COV-19 form Download.

Send e-mail to shirley.genaille@sapotaweyak.com:

1. Name:


2. Age:


3. Status Card Number:


4. E-mail:


5. Phone number:


6. Mailing Address:


7. Facebook ID/ Name(optional) if you can not be reached by phone or email:


8. Preferred means of contact:


9. Are you on income assistance?:


10. which services are you accessing?:
Canada Pension Plan
Employment Insurance
Workers Compensation
Canada Emergancy Response Benefits
Not employed
N/A

11. What barriers are you and your household currently experiencing that prevent you from accessing food security and/or meals? check all that apply:
Immobility (inability to move, injury, or pain)
Living with Disabilities ( Mental or Physical)
Self Isolating
Sick/ Chronic Illness
Lack of income
Tested Positive for COVID-19
Other

12. what are the immediate needs of your family? Check all that apply:
Food
Housing
Medical Consultation
Assistance in locating income Support
Cultural Support
Hygiene Products and/or Feminine Products
Cleaning Supplies
Medical Supplies
Mental Health Support

13. Please provide all of the following information for any and all dependents living in your household:
First Name/Last Name
Gender/Non-binary
Age
Sapotaweyak Cree Nation Status Card Number


14. Does your family have the following means of communication? check all that apply:
IPad/Tablet/Notebook/Computer with internet access
Electronics with no wifi access
Cellphone/home phone
Other


15. Any other information you would like to add to support your application:


16. Are you:
Single
Family
Youth

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