Quartz Valley Indian Reservation in Fort Jones , CA 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the applicant's name and email address. Ensure that your contact information is accurate for any follow-up communications.
  3. Indicate whether you or someone in your household has experienced a negative impact due to COVID-19 by selecting 'YES' or 'NO'.
  4. Provide your mailing and physical addresses, along with home and cell phone numbers for complete identification.
  5. List all Tribal members in your household, including their names and enrollment numbers. This information is crucial for processing your application.
  6. Detail the requested services and associated costs. Attach supporting documentation showing current account/payment information or recent receipts as required.
  7. Complete the attestation section by signing and dating the form, affirming that all provided information is accurate.

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Tribal membership is 397 as of February 2023.
QVIR was originally chartered as a result of the Indian Reorganization Act of June 18, 1934, or Wheeler-Howard Act. That federal legislation established it as a sovereign, self-governing, federally recognized American Indian Tribe. The Tribe adopted its constitution and by-laws on June 15, 1939.