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Region 4 Grocery Gift Card Application

During this challenging time, Region 4 is supporting Métis citizens who have been adversly impacted by COVID-19 with a one-time grocery gift card.

$75 for individuals
$125 for families with 1 or 2 dependents
$150 for families with 3 or more dependents

To apply for a card, please fully complete the application form. Our staff will be in touch soon to verify your application.

Are you a Métis citizen residing in Region 4?*
- Yes
- No
We're sorry, this application applies only to Métis citizens in Region 4 at this time. Thank you
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Email*
Phone*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is your home address the same as your mailing address?*
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you currently employed?*
- Yes
- No
Are you a student?*
- Yes
- No
Total Monthly Income*
Are there others living in your household?*
- No
- Yes
How many dependents are you claiming
Dependent Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Relationship to you*
Dependent Name
First Last
Date of Birth
MM slash DD slash YYYY
Relationship to you
Dependent Name
First Last
Date of Birth
MM slash DD slash YYYY
Relationship to you
Dependent Name
First Last
Date of Birth
MM slash DD slash YYYY
Relationship to you
Dependent Name
First Last
Date of Birth
MM slash DD slash YYYY
Would you like to receive email updates and news from us?*
- Yes
- No
Relationship to you
Please tell us how you have been affected by COVID-19
I verify that all information provided above is correct and accurate.*
- Yes
Disclaimer

As our office is closed to the public, gift cards will be sent out in the mail. In the event that demand outstrips supply, we will prioritize those members most in need. Please note that submission of this application means that you will be added to the Region 4 email subscription service. You may choose to unsubscribe at any time.
Please press the "Submit" button only once.

Get in Touch:

MNA Region 4

Phone : 780-944-9288
Fax: 780-455-5546
Toll Free: 1-800-588-4088

Office Address:
Métis Regional Council - Zone IV
11724 - 95 St.
Edmonton, AB T5G 1L9

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Region 4 Grocery Gift Card Application

Disclaimer

MNA Region 4