All Tribal offices are closed on December 6th for an All Staff Meeting. SCHC calls will be routed to the Gatekeepers.

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Forms

< Go to Services & Programs Page

All forms available on our public webpages are listed below. Departments are listed in the order they appear in the website menu. Additional forms can be found in the Member Area portion of the website.

Important

Please read the policies (if applicable) and information on the pages that are linked before filling out the applications and forms.

Click to go to a section on the page.

Tribal Government
Our Heritage
Services & Programs
News & Events
Employment

Services & Programs

Housing

STHD Application
Includes Homeownership, Home of Your Own, Low Rent (Siletz & Lincoln City), Elder/Disabled Rental Assistance, Emergency Voucher), Property Management, and Elders Cottage.
Authorization for Release Form

Home Ownership Programs

Go to Home Ownership Programs Page >

Down Payment Assistance
HAF Pilot Program

Rental Programs

Go to Rental Programs Page >

Workforce Housing Application
Emergency Rental Assistance

Development & Modernization

Go to Development & Modernization Page >

HDRHAP Application
Rehabilitation Application
Rehabilitation Update Application
Sanitation Facilities Application

Education

Student Incentive Program

Culture and Language

Go to Culture and Language Page >

Cultural Activities Request Form

Head Start and Childcare

Go to Head Start or Childcare Page >

Head Start Application
Childcare Assistance Application
Childcare Provider Application

Youth

Go to Youth Page >

JOM Application
JOM Request for Services
Youth Activities Form

Post-Secondary Education and Scholarships

Go to Post-Secondary Education or Scholarships Page >

Higher Education Application
Graduate Grant Application
Job Placement & Training Program
Adult Education
Arthur S. Bensell Memorial Scholarship
Pepsi – Craig Whitehead Scholarship
Siletz Scholarship
Cathern Tufts Memorial Scholarship

Healthcare

To to Healthcare Forms & Policies Page >

Annual Update Form
General Patient Consent
Authorization to Discuss Medical Information w/ Others
Payment Policy
Authorization for the Use & Disclosure of PHI
Request Accounting Disclosures
Request for Correction Amendment
Request for Restriction(s)
Request for Revocation for Restriction(s)
Consent for Alt. to Bring Minor to App.

Other Forms

Exercise Program Application (Diabetes Program)

Go to Diabetes Program Page >

Social Services

Indian Child Welfare

Go to ICW Foster Parent Page >

Foster Home Application
Foster Parent Questionnaire

Elder Services

Go to Elder Services Page >

Monthly Stipend Direct Deposit Form
Elders WEX Application

USDA Food Distribution

Go to USDA Application Page >

FDPIR Application
Shelter Utility Expense Verification
Zero Income Worksheet
Exempt Income Document
Excess Medical Expenses Deduction

Natural Resources

Visit Fish and Wildlife Page for Latest Tag Drawing

Other Programs and Services

Minor Trust Request for Funds

Go to Minor Trust Page >