Forms

Some forms are required to be mailed rather than submitted online. If an online form is not available, please review the instructions on the downloadable PDF. The instructions will indicate if you can submit your PDF via email or if you need to mail it in along with pertinent supporting documents. For further information about a program or service, please visit the department’s web pages or use the contact information provided.

Services

Member Service Request Form

Enrollment

Tribal Enrollment
Please visit Tribal Enrollment for additional information.

Change of Address (Downloadable PDF)

Voter Registration Form (Downloadable PDF. Must be physically mailed.)

Tribal ID Request (Downloadable PDF and instructions)

Application for Enrollment (Must be physically mailed.)

Instructions
Downloadable Form

Relinquishment

Absolute Relinquishment – Adult

Absolute Relinquishment – Minor

Conditional Relinquishment – Adult

Conditional Relinquishment – Minor

Health Services

Ponca Health Services
Please visit our health services page to learn more about our offerings and clinics.

Patient Registration Intake Form and Authorization

Diabetes Education Assessment

Patient Health Summary – Adult

Patient Health Summary – Child

Human Services

Ponca Tribe of Nebraska Department of Human Services
Please visit the social service page to learn more about programs and services.

Emergency Assistance – Service Area Application (Downloadable PDF)

Emergency Assistance – Out of Service Area Application (Downloadable PDF)

Burial Assistance –

Funeral Announcements –

Education

Ponca Tribe of Nebraska Department of Education
Please visit the education page to learn about additional requirements.

Financial Aid – Higher Education Program (Downloadable PDF)

GED Incentive Program (Downloadable PDF)

Youth Initiatives Program Cover Letter
Youth Initiatives Program Application (Downloadable PDF)