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Sisseton Wahpeton Oyate Big Coulee Youth Board | (Sisseton Wahpeton Oyate)

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DATE FILLED OUT: BCYB DATE RECEIVED:
Request Verified: Amount Distributed: $ CHECK #: Distribution Date: Aug- -19
Sisseton Wahpeton Oyate
Big Coulee Youth Board | Siceca Iyakaptapi Youth Board
2019 School Clothes Assistance Application (Pre-K -HS)
Application Deadline: September 31, 2019
Completed Application + Proof of School Registration
ALL documents required to receive full amount of School Clothes Assistance.
Parent/Guardian:
Phone:
Text: Y/N
Email Address:
Current Mailing Address:
Youth Full Name
School Name
Date of Birth
Grade
1
2
3
4
5
6
On behalf of the above youth, I hereby:
1. State the above youth are enrolled members of the SWO and registered Youth members of Big Coulee District.
2. I have completed the 2019 Youth Roster Form online to update the BCYB Youth Roster.
3. All Youth must be on the Big Coulee Youth Roster by July 25
th
, 2019 District meeting.
4. All applicants must submit proof of school registration from Pre-K/Head Start to High School.
5.
You MUST attach a copy of the most current court order stating that you have physical custody of the above
named child(ren) or documentation of emergency/temporary placement from Child Protective Services.
a. Please note: If documentation is falsified, the Big Coulee Youth Board has the authority to report fraudulent activity
to law enforcement and take measures to ensure the integrity of the funds we are entrusted with.
b. Respectfully, BC Youth Board aims to honor the trustworthiness of everyone, unfortunately there have been
accounts of deception regarding the custody of children for youth assistance and these are the measures we must
take.
Parent/Guardian Signature Date
Distribution Day 1: Monthly Youth Meeting, Monday, Aug. 12
th
@ BC District Center 6:30-8:30PM
Distribution Day 2,3: Culture Night, Monday, Aug. 19
th
or 26
th
@ BC District Center 6:30-8:30PM
Distribution Day 4: Back 2 School Bash, Tuesday, August 20
th
@ Memorial Park 5:30-8:30PM
Mailed to the address above. Relative Pick Up: _______________________
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Sisseton Wahpeton Oyate Big Coulee Youth Board (Sisseton Wahpeton Oyate)

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Completed 20 July 2020

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