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FORMS

COVID-19 ASSISTANCE

QVIR COVID-19 Assistance
File Size: 109 kb
File Type: pdf
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MLIHA COVID-19 Assistance
File Size: 128 kb
File Type: pdf
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MLIHA COVID-19 Homeless Assistance
File Size: 586 kb
File Type: pdf
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EMPLOYMENT APPLICATIONS


Job Application - ANAV Health Clinic
File Size: 66 kb
File Type: pdf
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Job Application - Tribal Office
File Size: 57 kb
File Type: pdf
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Work/Labor Force Application
File Size: 581 kb
File Type: pdf
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Workforce Policy*
File Size: 2829 kb
File Type: pdf
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*Persons interested in Workforce employment must complete a new application to update his/her information for the current year.  Applicants must submit a completed application to the Human Resource Generalist in order to be eligible for Workforce recruitment.

MEMBER & EMPLOYEE FORMS

EDUCATIONAL & SOCIAL SERVICES ASSISTANCE
Provider Time Sheet 1st-15th
File Size: 128 kb
File Type: pdf
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Provider Time Sheet 16th-31st
File Size: 128 kb
File Type: pdf
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NGD Education Application
File Size: 188 kb
File Type: pdf
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NGD Education Policy Acknowledgement
File Size: 155 kb
File Type: pdf
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Hardship Application
File Size: 99 kb
File Type: pdf
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2021 LIHEAP Application
File Size: 321 kb
File Type: pdf
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LIHEAP assists low-income Quartz Valley Indian Reservation households with their energy assistance needs. Payments are made on behalf of QVIR Tribal members for energy needs such as wood, propane, and electricity. This program has limited subsidy and is only obtainable until funds are depleted.
IMPORTANT INFORMATION
​REGARDING LIHEAP FRAUD

To obtain a copy of a "Fraud Reporting Form", ​please click here
ENROLLMENT
Enrollment Application
File Size: 332 kb
File Type: pdf
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Tribal ID Form
File Size: 74 kb
File Type: pdf
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Address Update Form for Enrollment
File Size: 1603 kb
File Type: pdf
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QVIR General Assistance Policy
File Size: 227 kb
File Type: pdf
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QVIR General Assistance Application - Adult Member
File Size: 139 kb
File Type: pdf
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​
FINANCIAL ASSISTANCE
Authorization for Check Release
File Size: 154 kb
File Type: pdf
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Loan Application - Members Only
File Size: 10904 kb
File Type: pdf
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Loan Policy & Procedure
File Size: 205 kb
File Type: pdf
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NGD Donation Request
File Size: 41 kb
File Type: pdf
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NGD Child's Request Form
File Size: 149 kb
File Type: pdf
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NGD Sponsorship Request
File Size: 183 kb
File Type: pdf
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Reimbursement Form
File Size: 77 kb
File Type: pdf
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Voluntary Deduction Request - Employee
File Size: 1617 kb
File Type: pdf
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Voluntary Deductions Request - Tribal Members
File Size: 2088 kb
File Type: pdf
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NGD Release Form (Minor to Adult)*
File Size: 1866 kb
File Type: pdf
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*Please note that QVIR does not accept copies of the NGD Minor Request form.  This includes faxed copies.  All submitted NGD Minor Requests must be originals.

​MISCELLANEOUS
*Please note that it is the responsibility of each member to notify QVIR when the member changes his/her address.
Change of Address Notification
File Size: 72 kb
File Type: pdf
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Complaint Form
File Size: 261 kb
File Type: pdf
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Facility Use Request
File Size: 50 kb
File Type: pdf
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Request for Information
File Size: 21 kb
File Type: pdf
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Permission to Release Information
File Size: 154 kb
File Type: pdf
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2020 Letter of Intent Board Member
File Size: 67 kb
File Type: pdf
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2020 Letter of Intent Boards & Committees
File Size: 66 kb
File Type: pdf
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