Delaware Nation
2020 CARES Elders General Welfare Assistance Program
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
By the approval of the Delaware Nation Executive Committee, it has been decided that there is a
great need to provide general welfare assistance to Delaware Nation Elder Citizens who have been
affected by the COVID-19 Pandemic due to increase grocery prices. An elder is defined as an
enrolled tribal citizen who is 60 years old or older as of date of application.
This program shall provide assistance through the 2020 CARES Act funding in the form of a Wal-
Mart gift card to purchase groceries, medical supplies/equipment and cleaning supplies Assistance
shall be available on a monthly basis during the COVID-19 Pandemic or until the CARES funds
are no longer available. Assistance shall be $150 for a household of one, $300 for a household of
two, and $450 for a household of three or more or where the elder is supporting/raising children.
Incomplete applications will not be accepted. Please ensure proof of enrollment is submitted
with application.
Number of people living in your household: ______
COVID-19 Impact (Please check all that apply):
□ Increase cost of groceries due to COVID-19
□ Need of additional medical supplies and/or equipment
□ COVID-19 symptoms resulting in quarantine or social distancing
□ Daycare, School, or any educational institute closure (if children are in the household)
□ Difficulty in making rental payments, mortgage payments and utility payments
I hereby certify that I have been affected by the COVID-19 pandemic, including but not limited to
the list above.
Delaware Nation Elder (Please Print):_______________________________________________________
Mailing Address (to send gift card):_________________________________________________________
__________________________________________________________________________________
Signature:______________________________________________ Date:_____________________
Delaware Nation Enrollment #__________
**DO NOT WRITE BELOW THIS LINE**
Date Received:__________________________ Enrollment Verified:__________________________
Approved Amount:______________________ Applicant Name:_____________________________
Household Composition:__________________ Date Assistance Mailed:_______________________
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