Vaccination Incentive Assistance Application
Overview:
Vaccination Incentive Program is for the enrolled Apache Tribal members who received the vaccination for COVID-19.
Members must be fully vaccinated as follows:
- Moderna — 2 shots
- Pfizer — 2 shots
- Johnson & Johnson — 1 shot
This assistance is geared to promote the Apache Tribal members to get fully vaccinated and to do their part in helping the community out in preventing the spread of COVID-19.
Process of the Application:
- Must have a completed Application.
- Copy of Vaccination Card (Both sides) -OR- Copy of Vaccination Shot Record sheet (must be from Clinic or Hospital)
- Copy of Tribal ID
All information on the Application Form is required and must be filled out completely. You must also upload all supporting documents.
If the application is not completed or is missing documents, we will be unable to process your application.
Vaccination information:
Must be Pfizer, Moderna or Johnson & Johnson for COVID-19 vaccination shot.
Adult 18 and Older
- Pfizer – must have two and or three vaccinations lot # and Date on COVID-19 Vaccination Record Card.
- Moderna – must have two and or three vaccination lot # and Date on COVID-19 Vaccination Record Card.
- Johnson & Johnson – must have one vaccination lot # and Date of COVID-19 Vaccination Record Card.
Minor 12 years to 17 years old
- Pfizer – must have two and or three vaccinations lot # and Date on COVID-19 Vaccination Record Card.
- Moderna – must have two and or three vaccination lot # and Date on COVID-19 Vaccination Record Card.
Type of Assistance
$250.00 in a Wal-Mart Gift Card or Check
- Minor 12 years to 17 years old will be receiving a Wal-Mart Card.
- Adult 18 and Older will be receiving a Wal-Mart Gift Card or a Check.
Wal-Mart Gift card will be able to be picked up or mailed to the tribal member depending on the tribal member’s living location.
Check in the amount of $250.00 will be processed and will be going through the ATO check procedures.
Please Complete The Following Online Form To Get Started
Vaccination Incentive Assistance Application
Incentive for full vaccination of Tribal Members.