_Jt_ T COLD LAKE FIRST NATIONS P.O. Box 1769 I Cold Lake, AB I T9M 1P4 Phone: 780-594-7183 I www.clfns.com

Urban Member COVID- 19 Assistance Application This application is to provide assistance with food purchasing for Cold Lake First Nations off-reserve or urban members. Please ensure application form is complete with all required documentation before submission. Incomplete application forms and documentation will result in a delay of processing.

Eligibility: • Must reside outside of the Cold Lake & Bonnyville Region. • Must be a Cold Lake First Nations Member. Scanned copy or clear picture of applicant’s Status Card is required with submission. • One card per household. Confirmation of address is required. Scanned copy or clear picture of license, bills, or bank statement etc.

*documentation required is used for funding reporting purposes*

Please email this completed form, proof of residency and copy of status card to [email protected] Applicants info:

Last Name: First Name:

Mailing Address: ADDRESS CITY PROVINCE POSTAL CODE

Phone number:

Email:

Sobeys Gift Cards can be redeemed across in all Sobeys bannered grocery stores. These include Sobeys, IGA*, Garden Market IGA, , , FreshCo, Chalo! FreshCo, , Lawtons Drugs, Needs, Fast Fuel and Price Chopper (ON only). However they are not redeemable at the BC Market Place IGA locations in .

PC (President’s Choice) PC gift cards can be redeemable at Club Entrepot, , , Your Independent Grocers, , Loblaw Great Food, Maxi, Maxi and Co, , , Save Easy, , , SuperValu, Value-mart, Wholesale Club, , Zehrs Great Food. If you have any questions or concerns regarding application process please contact Pam Janvier at (780) 594-7183 ext 247, (780)815-1181 or [email protected]

Other (please identify)______

If you have any questions please contact Pamela Scanie at: 780-815-1586