Forms & Downloads

Download Forms

Social Services Program Applications

• Burial Assistance Application
• Application for Services – This application includes: Child Care, General Assistance, Vocational Tuition Assistance, and Higher Education Scholarships.
  Fillable: Applications for Services 

Chugachmiut Heritage Preservation

• Accessing Choices in Education (ACE) Application 

Health Services Forms

• Anesia Anahonak Moonin Clinic Registration Packet (Port Graham)
• Arch Priest Nicholas Kompkoff Clinic Registration Packet (Chenega)
• Nanwalek Clinic Registration Packet (Nanwalek)
• Chugachmiut Regional Health Center Registration Packet (Seward)
• Tatitlek Clinic Registration Packet (Tatitlek)
• Chugachmiut PHI Attestation Form – Reproductive Health Records
• Chugachmiut Authorization for Disclosure of Substance Use Disorder (SUD) Records Request
• Chugachmiut Consent to Treat and Bill
• Chugachmiut Notice of Privacy Practices
• Patient Rights and Responsibilities

Behavioral Health Forms

• • Current Intake Packet

Recovery Camp Forms

• Llangcarwik Recovery Camp – please see events calendar
• Recovery Camp Application

Women’s Violence Intervention

Headstart Forms

• 2024-2025 Birth to Five Enrollment Application
• Chugachmiut 2024-2025 Parent Handbook
• Chugachmiut Dental Exam Form

Trust & Land Division

• Housing Improvement Program Application – Learn more here.