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Applications for NOD assistance can be obtained through NOD Board members and volunteers, or downloaded here. Once NOD receives an application, a three-member NOD application committee (chaired by the Vice President) reviews applications with all applicant information being strictly private and confidential. If approved by the Committee, the application is presented to the four-person NOD Board of Directors for approval. The Board and Application Committee approve or reject applications by majority vote. Applicants may grant NOD permission to use their name for fundraising purposes. 

To Applicant:

1. You must be a current resident of Dubois or Crowheart and have resided here for one year.Proof of residency is established by providing a copy of oneof the following documents at least one year old showing a Dubois or Crowheart physical address:

  • Utility bill 

  • Rent receipt from landlord 

  • Property tax statement 

  • Hunting or Fishing License 

  • Any other form of documentation, minimum of one year old, with a Dubois or Crowheart physical address

2. Attach copies of bills you are requesting NOD to pay as required on Page 6. All payee contact information must be included on copies. 

  • Include a copy of each bill (e.g. phone bill, power bill, propane bill, medical/dental treatment bill, rent or lease agreement, etc.). 

  • If you only have a treatment plan or estimate from a medical provider, provide a copy of that document if actual bills are unavailable. 

  • For gas and grocery costs, provide an estimate based on your monthly need. 


3. Attach all required documentation as specified in each section of the application. 

Important Information: 

  • NOD will not pay you or reimburse you for expenses submitted on this application. 

  • NOD pays service providers directly based on bills that are submitted with this application. 

  • NOD will not make payments towards assets such as vehicles and mortgage payments. 

  • Payments may be denied or reduced if: 

  1. You have health, dental, or vision insurance.

  2. You have not documented your efforts to obtain other resources for assistance.

  3. Your needs do not meet the mission of Needs of Dubois. 

  • NOD reserves the right to verify any and/or all sources of information. 

  • If any information provided on the application is proved to be false, the application will not be considered. 

  • All information in this application is confidential unless you grant permission to NOD to use your information for fundraising purposes. 

  • Application processing time is approximately two weeks. 



Application Form

Application for Assistance

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