Declaration of Understand Fillable PDF Form

Please complete the following form. The completed form will be emailed to the email you have specified. Please upload the form in your TANF application or in the upload portal.

Please contact XXXXX for questions or concerns regarding this process.

I understand and agree that I am requesting aid from Chippewa Cree TANF Program (herein referred to as CCTTP) and that I will comply with eligibility requirements. I may be asked to comply with some of these requirements before any aid can be given. I understand the statements I have made on this form may be checked and verified. I understand if I do not qualify for immediate need, other requested services will be approved/denied within standard TANF guidelines. I declare under penalty of perjury under the laws of the United States of American and the State of Montana the information I have provided is true, correct and complete to the best of my knowledge.

Applicant Name(Required)

First Last

In order to protect your private information the completed PDF form will be encrypted with a password. Please type a password you can remember.

Password(Required)

The completed PDF form will be emailed to you please provide an email address below.

Email(Required)

Applicant Signature

Applicant Date Signed

Co-Applicant Signature

Co-Applicant Date Signed