Skip to content

Quinault Indian Nation

Home
Applications & Forms
Documents Upload
Information

Quinault Indian Nation

Home
Applications & Forms
Documents Upload
Information

Incentive Request

If you would prefer to download and print this form to submit by email or in person, please click here. To submit by email to TANF@quinault.org.

Important

An email address is required for this form to be HIPAA compliant. If you do not have an email address, please call the office for assistance in setting up an email address.

Person Requesting Incentive:

Participant First Name(Required)

Participant Middle Name

Participant Last Name(Required)

Participant Suffix (Jr, SR, II)

Date of Request(Required)

MM slash DD slash YYYY

Phone(Required)

Email(Required)

Person Incentive is for:

Participant First Name(Required)

Participant Middle Name

Participant Last Name(Required)

Participant Suffix (Jr, SR, II)

Incentives:

Incentives – Youth

Check All that Apply

8th Grade Promotion $200

High School Graduation $750

ISP Completion $50

Court Completion $50

Special Recognition $50

Incentives – Adult

Check All that Apply

Youth Wellness/Sports Physical $50

Youth Dental Checkup $50

Youth School Conference Attendance $50

Marriage, Before $750

Marriage, After $750

Bachelor’s Degree $500

Prenatal Appointments (8) $150

Social Security Benefits, Adoption, Foster Care License $250

Reunification Completion $250

Work Activity Log (WAL) – On Time and In Compliance $50

Case Closure – In Compliance $50

Reinstate Driver’s License $250

Employment $100

Volunteer Placement – Based Upon Hours Assigned and Completed

Incentives – Youth or Adult

Check All that Apply

Obtain Driver’s License $100

GED or High School Equivalency $300

Inpatient/Outpatient Treatment Completion $250

Tech/Vocational Program Completion w/Certification Completed $300

Associates Degree $500

Other Approved Event

Other Approved Event-Specific Incentive (Determined by Program Manager)

List the Event Description:

Issuance(Required)

Key2Benefits Card

Check

Direct Deposit

Gift Card: Pick Up At the Office

Gift Card: Other Arrangements

Issuance Special Arrangement

List Arrangement Requesting:

Certification(Required)

I ATTEST THAT

all of the information that I have provided is true and correct to the best of my knowledge. I also acknowledge that processing time may take up to five business days.

Date Signed(Required)

MM slash DD slash YYYY

File Upload

Attach supporting documents here.

Drop files here or

Max. file size: 40 MB, Max. files: 20.

Δ

© 2025 Quinault Indian Nation TANF

© 2025 Quinault Indian Nation TANF