2022 Holiday Disbursement Program Application

Please fill out a SEPARATE FORM FOR EACH PARENT and ONE parent will fill out a form for their
child(ren).

Please list ALL CHILDREN WHO ARE IN YOUR CUSTODY AND CARE, only status Indians registered with
CLFN will receive payment through the Holiday Disbursement Program.

ANY PERSON WHO IS ENTITLED TO THE CLFN 2022 HOLIDAY DISBURSEMENT PROGRAM AND
WHO DOES NOT SUBMIT AN APPLICATION BY JANUARY 31, 2023 SHALL BE FORFEITED WITH NO EXCEPTIONS