Shareholder Direct Assistance Program (SDAP) Application The TNC Shareholder Direct Assistance program (SDAP) is funded through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which allows TNC to provide a one-time payment of direct cash assistance to TNC shareholders who have experienced additional expenses and/or loss of income related to the COVID-19 pandemic between March 1, 2020 and December 31, 2021. Eligible TNC shareholders and descendants who are 18 years of age and over, may qualify for up to $3,500 themselves and up to $1,000 for each eligible dependent (must be a TNC shareholder or descendant) under the age of 18. TNC shareholders and descendants who are 18 years of age and over, may apply and should submit only one application to TNC. Minors are not eligible to submit their own application. Please carefully read and complete this application in its entirety. Please print clearly.Personal InformationName(Required) First Middle Initial Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) *If you believe your contact information in the TNC Shareholder portal (www.myTyonek.com) may be outdated or different than what you indicated above, please sign below to authorize TNC to update your information. By signing below and if your SDAP application is approved, this will be the address that your check is mailed to, if selected as your preferred method of payment.Signature(Required) By typing your name in the Digital Signature field, you are agreeing that it is the legal equivalent of your manual signature. Date(Required) MM slash DD slash YYYY Date of Birth(Required) MM slash DD slash YYYY SSN (Last 4 digits)(Required)Please enter a number from 0000 to 9999.Shareholder Status(Required) I am a current TNC Shareholder Descendant Non-Shareholder Fiduciary I am a U.S. citizen(Required) Yes No I am 18 years of age or older(Required) Yes No Financial ImpactsDuring the period March 1, 2020, through December 31, 2021, I had or I am having the following financial struggles as a result of the COVID-19 pandemic, for which I have not been reimbursed. (Please check all that apply):Financial Impacts I have suffered loss of income due to COVID-19 I have been laid off, furloughed, given reduced hours, or a reduced salary due to COVID-19 I need/needed housing assistance to avoid foreclosure or eviction due to financial difficulties resulting from COVID-19 I have incurred additional household expenses and/or utility costs because of the need to stay at home, isolate, and/or adhere to public health mandates and recommendations issued in response to COVID-19 including electricity, gas, propane, firewood, water, sewer, waste disposal, internet, phone, and/or other costs I have incurred increased expenses for groceries, food, and/or nutrition assistance necessary to sustain my health and well-being due to COVID-19. Due to supply-chain and food scarcities, I had to purchase subsistence materials including fishing gear (fishing poles, permits, hooks, line, and nets), bullets, buckets, canning supplies, and other subsistence items, as needed I have incurred increased expenses for care for dependents as a result of COVID-19, including but not limited to additional adult care and/or childcare costs, such as costs for the care and feeding of children not able to attend school or daycare because of closures due to COVID-19 I have incurred expenses related to online or remote learning and expenses to maintain and support the educational needs of school-age children, including post-secondary school, as a result of school closures or changes made by schools in response to COVID-19 I have incurred expenses as a result of the public health mandates and recommendations issued in response to COVID-19, including costs to quarantine, self-isolate, comply with social distancing mandates, obtain personal protective equipment (PPE), masks, mask making equipment and supplies, cleaning/disinfectants, and other similar items I have incurred medical costs or prescriptions drugs (including but not limited to mental health issues) related to COVID-19 or suspected exposure to COVID-19, including for COVID-19 tests I have incurred additional expenses for transportation because of COVID-19 Please describe below any additional financial hardships you have experienced that are not covered in the above optionsDid you have at least $3,500 in loss of income and/or additional expenses/costs, due to the COVID-19 pandemic for which you did not receive assistance or that were not otherwise repaid?(Required) Yes No What did your loss of income and/or additional expenses/costs total?(Required) *You must provide a total amount if you answered “No.” This line cannot be left blank.Minor DependentsEligible dependents are minors under the age of 18 who lived with the applicant (must be a TNC shareholder or descendant) for at least six of the past 12 months and for whom the applicant provided more than 50% of the dependents’ financial support over the past 12 months. For shared custody arrangements, additional documentation may be required.Do you have minor dependents?(Required) Yes No Dependent Information Name Date of Birth Age Actions Edit Delete There are no Depedents. Add Dependent Maximum number of depedents reached. Preferred Payment MethodA one-time SDAP payment will be remitted in the form of a mailed check or by direct deposit. Please check only one box below to indicate how you would like to receive your payment.Payment Method(Required) Check Direct deposit Acknowledgements, Certifications, and AgreementI certify that all of the information provided in this application is true and accurate. I understand that any misrepresentation or inaccurate information may result in a repayment of grant funds. I certify that no expense or financial hardship for which this grant is sought has been accounted for or reimbursed by any other Alaska Native Corporation, tribal government, state or local government, or other federal or CARES Act program (such as the Paycheck Protection Program or CARES Act grants from tribes or local governments). I understand that receipt of assistance funds may impact eligibility to receive certain public/welfare assistance benefits and that Tyonek Native Corporation may not advise me in this regard. I agree to retain reasonable documentation for a period of five years of the expenses that any grant funds are used towards and to assist with any further information necessary for verification of submitted information upon reasonable request by Tyonek Native Corporation.Digitial Signature(Required) By typing your name in the Digital Signature field, you are agreeing that it is the legal equivalent of your manual signature. Date(Required) MM slash DD slash YYYY Deadline to Apply is November 30, 2021!