ELD-Annual Food Assistance Application-Rev. January 2021
Elder Care Program Please direct any questions to the Concho Office:
Office hours: MON-FRI 8 am to 4 pm
P.O. Box 133—Concho, OK 73022 Phone (405) 422-7411 Fax (405) 422-8230
firstname.lastname@example.org Toll Free 1-800-247-4612 ext 27411
2021 YEARLY APPLICATION/CHANGE OF ADDRESS FORM
FOR MONTHLY FOOD ASSISTANCE
DUE B Y TH E 14TH O F TH E MO NTH
In order to be eligible for food assistance, to be mailed each month, you must be an enrolled member of the
Cheyenne & Arapaho Tribes and turning 55 or older during the month you apply.
APPLICATIONS ARE PROCESSED IN THE CONCHO OFFICE
Always provide your CDIB #
If NEW to the program, submit copy of your CDIB
Date of Birth
Phone ( ) Message Phone ( )
ALWAYS keep your address updated—every time you move, as soon as you move,
update with Elder Care & Enrollment! If we don’t receive your updated application by
of the month, your check will go to previous address.
New clients to Elder Care must submit their application by the 14
of the month
BEFORE you turn 55 years old.
Lost, mutilated, or stolen checks will not be replaced until a 60-day waiting period has
passed, at which time a new check will be issued if the previous check has not been
Checks are valid for 90 days—no checks will be reissued.
Tribal Member Signature Date
**RETURN BY THE 14
OF THE MONTH IN ORDER FOR THE FOOD CHECK TO BE PROCESSED THE FOLLOWING MONTH**
We do not mail checks to jails, prisons, homeless/day centers, general delivery addresses, or hotels/motels.