Yankton Sioux Tribe
CDC-Grant Services
Application For Internet Service
(On Reservation Only)

A Credit of $350 will be applied to your existing account and/or new account. These funds are proceeds from the CDC-Grant Award.

*IMPORTANT REQUIREMENT FOR ELIGIBILITY

All applicants must email Evelyn Frederick at: ystcovid20ef@gmail.com proof of the following:
1. YST Enrollment
2. Copy of the current bill with the applicant’s name on it.

Name

First Name

Last Name

Requested Date of Installation:

Contact Number:

(A daytime number where you can be reached)

Country

(###)

###

####

Mailing Address | City:

911 Address | City:

Will you be renting or owning your home?

Rent

Own

If renting, Landlord's Name:

Internet Service:

New Customer

Existing Customer

Vendor:

Address:

Account #:

Applicant's Signature:

I certify that the statements made on this application are true and correct to the best of my knowledge. I further understand that untrue or misleading statements may affect my eligibility for services. Please email applications to Evelyn Frederick ystcovid20ef@gmail.com or fax to 605-384-3830. If you have any questions, please feel free to call the Task Force office at 605-384-5683.

Application Date:

MM

DD

YYYY

Yankton Sioux TribeCDC-Grant ServicesApplication For Internet Service(On Reservation Only)

Yankton Sioux Tribe
CDC-Grant Services
Application For Internet Service
(On Reservation Only)