Kickapoo Tribe of Oklahoma - Kickapoo Tribe of ...
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Kickapoo Tribe of Oklahoma
Social Services Department Phone: (405) 964-4219
P.O. Box 70
McLoud, OK 74851
2021 School Clothing Allowance Program
Program dates: (July 26, 2021 – September 30, 2021)
Eligibility:
1. Student(s) must be enrolled with the Kickapoo Tribe of Oklahoma.
2. Parent/Guardian applying for the child, must be the custodial parent, legal guardian, foster parent or
caseworker at the time the application is processed in the school clothing office.
3. Student must be 3 years or older and must be enrolled in Head Start or Pre-K through the 12th grade at
the time the application is received.
***Head Start applicants are REQUIRED to provide a copy of the Head Start Program or Pre-
Kindergarten School’s License. NO exceptions for unlicensed programs or child care facilities.
Guidelines:
1. KTO School Clothing Program assists each enrolled student with $300.00 (Three Hundred Dollars)
from grades Head Start, or Pre-K through 12th grade.
2. Apply once per program year for each student, July 26, 2021 – September 30, 2021.
3. ONLY original applications will be accepted. Applications may either be submitted by mail, or turned
in at the Social Services office.
4. These guidelines have a set limit of 1 (one) request per student per fiscal year.
5. Once the application has been processed and approved, the students’ VISA card will be loaded in the
amount of $300.00 (Three Hundred Dollars). Each student must use their own card that was issued
to them.
6. The students are to KEEP and use their same card every year until that card expires, at which time they
will be issued a new card.
7. ALL RECEIPTS MUST BE TURNED IN WITHIN 90 DAYS.Required Documents:
Completed application must first be filled out by the parent/legal guardian.
Must submit a 2021–2022 class schedule or enrollment letter from the school. Schedule/Letter must
show students’ name, grade, school name, and year/date enrolled.
Copy of each students updated CDIB card. NO EXCEPTIONS.
Adults with custody of KTO children will need most current court documents, DHS approval letters of
verification showing you have custody or guardianship.
Receipt/VISA Guidelines:
1. The school clothing allowance is to be used to purchase school clothing, shoes, and/or uniforms ONLY.
Absolutely, NO school supplies allowed.
2. NO online shopping. Shopping online will automatically lock the card.
3. If school clothing allowance VISA cards lock up due to buying non-school clothing items, the Social
Services Department will not unlock the VISA card for (5) business days due to violation of these
Guidelines.
4. If misuse of the school clothing allowance is reported to the Tribe, the Social Services Department will
do a full investigation of the offense.
5. Legibly print the head of household name, student’s name and CDIB number on each receipt.
6. It is the parent/guardians’ responsibility to make copies of receipts for their records.
7. A $5.00 fee will be charged to replace a lost or damaged VISA card.
8. All clothing purchases receipts are to be turned in within ninety (90) business days from the date
money has been applied to the card for the student to be eligible for the following year. ONLY
original receipts will be accepted. After ninety (90) days, any money left on the cards WILL BE
PUT BACK TO THE TRIBE, and your card balance will be set to zero (0) until the next fiscal
year.Notification Text Alerts
Email and/or Mobile Text Alerts can be received for School Clothing Card users who sign up on the website
listed on the back of the card. This is how you will be notified once funds are added to the card. This is a fast
and easy way to check the balance of a card, to be notified once funds are added or when the balance is low.
To Sign-Up:
• Log on to the website on the back of your card: http://www.consumercardaccess.com/kickapootribe
• Enter your card number, 3 digit security number on the back of your card, and the security code in the
box.
• Click ‘Log In’.
• Select ‘Alerts’.
• After you have read the Terms and Conditions, check the box and click ‘Continue’.
• Click the ‘Add’ on the Contact Information.
• Enter an email address, a cell phone number and a nickname
for the child’s card, click ‘Submit’.
Note: If you only want email notifications, you must still fill in a
phone number even if it is a landline.
• Click on the ‘Add Declined Transactions’. This will tell you why
your transaction was declined.
• Select how you wish to be notified, email and/or mobile, click
‘Add’.
• If you want to be notified when your balance is low, select how
you want to be notified, and enter the Threshold Amount.
• Select how you want to be notified when your card has been
funded. Put $0.00 in the Threshold Amount, click ‘Finish’.
To check the balance of your card,
text the word “BAL” to 28542
(Three (3) free per month, then .20¢ each thereafter)PLEASE PRINT. KICKAPOO TRIBE OF OKLAHOMA
Application MUST be School Clothing Allowance Program Application
completed in FULL to
be accepted. Academic Year 2021 – 2022
❖ Student’s Information: (One form per student)
Student’s Name: ____________________________________________________________________________________
First Last MI
KTO Roll #: ___________________ Date of Birth: _______/_______/______________ Age: _____________
Name of School student is enrolled: ____________________________________________ Grade: _____________
❖ VISA Card Information:
Do you still have your VISA School Clothing Card? YES NO
If not, explain: _____________________________________________________________________________________
Card # (last 5 digits): __________________ FOR OFFICE USE ONLY:
Expiration Date: _____________________ New card #:
Expiration:
Amount:
❖ New Card Delivery/Notification Plan: (check one) List #:
PICK UP – (Phone) and/or (Text): __________________________________________________
Email: __________________________________________________
Other authorized person to pick up: _______________________________________________________
MAIL – to this address: _______________________________________________
_______________________________________________
❖ Parent / Legal Guardian / Foster Parent’s Information:
I am (check one): Parent Guardian Foster Parent
Name: ____________________________________________________________________________________________
First Last MI (Maiden)
Address: __________________________________________________________________________________________
PO Box / Street City State Zip
Phone: (________) _______________________ 2nd Contact Number: (________) _______________________
I MAKE THIS APPLICATION FOR CLOTHING ASSISTANCE FROM THE KICKAPOO TRIBE OF OKLAHOMA TRUE AND REQUEST THAT THE SCHOOL
VERIFY ENROLLMENT AND/OR ATTENDANCE.
________________________________________________ ______________________________
Parent/Guardian/Foster Parent’s Signature DateCONFIRMATION AND ACCEPTANCE FORM
I understand by accepting the School Clothing Allowance Program VISA Card for my child, that he/she will not
be eligible until the next school year. I have accepted the card for the following student:
Student: ___________________________________________ School Year: ________________________
1. I am aware that ONLY school clothing can be purchased for the student only.
2. I am NOT allowed to purchase school supplies, pay bills, purchase fuel, or food items.
3. I am NOT allowed to shop online. I am aware that in doing so may result in the card being locked.
4. I am aware that all transactions will be monitored for misuse or non-compliance.
5. The parent/legal guardian and/or student will be held responsible for repayment of misused funds.
6. ALL original receipts MUST be returned to the Social Services Department via mail or in person, with
the student’s name written on the receipts.
7. I understand the fee is $5.00 to replace a lost or damaged VISA card, and that the fee will come out of
the $300.00.
I agree to abide by the rules established, and I understand my child will not be eligible for this program
should I fail to abide by these rules and there will be NO EXCEPTIONS.
_____________________________________________________ ______________________________
Signature of Parent/Guardian Date
SOCIAL SERVICES PERSONNEL ONLY
Receipts received on: _______________________________ By: ________________________________
Notes:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Revised on 07/12/2021You can also read
