2025 December Holiday Assistance Form | Lower Elwha Klallam Tribe

You must have a signed note to pick up for someone else.

There can be more than one family unit in a single residence. Some homes have multiple families residing at the same address. Please provide information about YOUR particular family unit.

Local Checks' can be picked up on 12/15/24 at the dining hall from 11 AM to 7 PM

$300.00 - Enrolled LEKT 18+ member who live out of the LEKT service area. Out of area checks will be mailed on 12/10/25.

$500.00 - Local, enrolled 18+ LEKT members with families of 4 or less, with primary custody of at least one child under the age of 18.

$700.00 - Local, enrolled 18+ LEKT members with families of 5 or more, with primary custody of three or more children under the age of 18. (1 parent w/4 kids, or 2 caregivers w/3+ kids)

$200.00 - Local non-LEKT (unenrolled) 18+ caregivers with primary custody of one or more LEKT enrolled children under the age of 18. (These caregivers will be contacted by Social Services to coordinate disbursement of gift cards.)

Please select your Family Size(Required)

Please select your Family Size

$300 Check - $300.00 - Local Enrolled 18+ LEKT Members with zero minor children.

Your Holiday Assistance Check will be this amount.

$500.00 - Local, enrolled 18+ LEKT members with families of 4 or less, with primary custody of at least one child under the age of 18.

Your Holiday Assistance Check will be this amount.

$700.00 - Local, enrolled 18+ LEKT members with families of 5 or more, with primary custody of three or more children under the age of 18. (1 parent w/4 kids, or 2 caregivers w/3+ kids)

Your Holiday Assistance Check will be this amount.

$200.00 - Local non-LEKT (unenrolled) 18+ caregivers with primary custody of one or more LEKT enrolled children under the age of 18. (These caregivers will be contacted by Social Services to coordinate disbursement of gift cards.)

Your Holiday Assistance Check will be this amount.

Household Information

LEKT Applicant Full Name(Required)

First Middle Last

Date of Birth(Required)

Do you have an address change to report?(Required)

Yes

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Is your Spouse enrolled LEKT?(Required)

Yes

Spouse's Name

First Middle Last

Check Pick Up

You MUST have a signed note to pick up someone else's check or have your check picked up by someone else. This section of the form is intended to allow Tribal Members to authorize someone else to pick up their Holiday Assistance Check for them.

Do you want your check picked up by someone?(Required)

Signatures are required if you want someone to pick up your check for you.

Yes

Name of Person allowed to pick you your check

First Last Suffix

List the Full Name & Ages of child(ren) you have primary custody of along with ages as of 12/15/2024

How many child(ren) do you have primary custody of along under the age of 18 as of 12/15/2024

Child 1 Name

First Last

Date of Birth 1

Child 2 Name

First Last

Date of Birth 2

Child Name 3

First Last

Date of Birth 3

Child Name 4

First Last

Date of Birth 4

Child Name 5

First Last

Date of Birth 5

Child Name 6

First Last

Date of Birth 6

Child Name 7

First Last

Date of Birth 7

Child Name 8

First Last

Date of Birth 8

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Comments(Required)

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