OSAGE NATION FOOD ASSISTANCE PROGRAM APPLICATION

This Application is submitted for the purpose of applying to the Osage Nation Food Assistance Program. Submission of an application does not guarantee approval. The application must be completed and returned to 102 Midland Street, Pawhuska, OK 74056. The application period is June 1, 2026 through 30, 2026. Applicants will be informed if they have been accepted within two (2) weeks after application period has ended.

I. Applicant Information
Name Name First Last
Date Of birth Date Of birth / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
II. Please answer the following questions
Are you a member of the Osage Nation?
Are you 18 years or older?
Is a copy of Osage Nation membership card attached to application?
Please upload copy of Osage Nation membership card (if applicable)

Attach Files
III. Please select preferred type of food assistance (select all that apply)
Harvest Land

Harvest Land Canned Items Fresh Produce Other Shelf Stable Items
Butcher House

Butcher House custom Processing Retail Meat
IV. Signature

I fully understand that submission of an application does not guarantee receipt of assistance, and that resources will be allocated or withheld according to availability of funds and other considerations. I authorize the Osage Nation Department of Natural Resources to obtain necessary information from other source(s) to verify my information and establish my eligibility for assistance, and I hereby authorize such other source(s) to release necessary information. I have read and fully understand the policy guidelines provided with this application.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

OSAGE NATION FOOD ASSISTANCE PROGRAM APPLICATION

OSAGE NATION FOOD ASSISTANCE PROGRAM APPLICATION

I. Applicant Information

II. Please answer the following questions

III. Please select preferred type of food assistance (select all that apply)

IV. Signature