BOIS FORTE ELDERLY NEEDS PROGRAM
Purpose: The purpose of the Bois Forte Elderly Needs Program is to assist Bois Forte Elderly or Handicapped/Disabled adults who have needs that cannot be met by other programs and resources. It is intended to be a “last resort” program and applicants must apply to other agencies and be denied.
Who is eligible?
Bois Forte Band members who reside in Saint Louis, Koochiching and Itasca Counties are:
How do I apply for assistant?
Bois Forte Elderly Needs Program
Attn: Program Coordinator
13071 Nett Lake Road, Suite A
Nett Lake, MN 55772
Who do I call with questions?
Questions should be addressed to the Elderly Needs Program Coordinator please call 1-800-223-1041 or 218-757-3295
What may I request?
All requests must be for goods or services that contribute to the well-being and/or safety of the applicant.
The following items are the only items available through this program. If the item is not listed it may not be requested:
Furnace Refrigerator W&S Repairs Washer and/or Dryer Water Heater Septic Pumping Kitchen Range/Stove Air Conditioner (window mount only) Freezer Upright or Chest Couch/Sofa Main/Storm Door Carpet/Floor Covering Recliner Handicap Accessibility Needs Kitchen Table/Chair Set Ramp Bed and/or Dresser Set
Are there any other things that I cannot request?
Yes. This program will not pay your utility bills (electricity, heating fuel of any kind, water, community sewer, or phone bills).
This program will not pay for anything intended as a gift for another or that will be used primarily by someone who is not an eligible applicant.
How much assistance can I get?
The program will provide assistance of up to $600.00 per household (with a minimum of $50.00) towards the purchase of 1 item listed above.
If the cost of the item exceeds $600.00 it will be the applicant’s responsibility to pay remainder of the balance and you must demonstrate the ability to pay the remaining balance.
If I already purchased a qualifying item can I apply for help in paying for it?
No. The program does not allow for reimbursements.
How often can I apply?
After receiving assistance you will be eligible again in two (2) calendar years after your award, unless, the request is for an emergency that was beyond your control.
ELDERLY NEEDS PROGRAM
Address_____________________________ Phone #_________________________
____________________________________ Bois Forte Enrollment #______________
Are you disabled or handicapped? _____ Yes _____No (if yes please attach proof)
Do you ____ Rent or ____ Own your home?
Amount requesting ($600.00 Max) $________ for item checked below: (attach vendor quote)
( )Furnace ( )Refrigerator ( )W&S Repairs ( )Water Heater ( )Ramp
( )Washer and/or Dryer ( )Septic Pumping ( )Kitchen Range/Stove ( )Recliner
( )Air Conditioner ( )Couch/Sofa ( )Main/Storm Door ( )Accessibility Needs
( )Freezer Upright or Chest ( )Carpet/Floor Covering ( )Kitchen Table and Chair Set
( )Bed and/or Dresser Set
Income (Social Security, SSI, Wager, Unemployment, Retirement etc.) Please attach check stub, letter, and statement.
Monthly Total $_____________________
I, the undersigned, do hereby agree to accept this item and to have sole responsibility of the item. The above shall remain with me in my place of residence. I also verify that the above is true and correct to the best of my knowledge.
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