New to Bis-Man:

    Your Name: (required)


    Your Email: (required)


    Address:


    City:


    State:


    Zip:


    Phone:


    Have you moved from:
    A reservationAnother urban area
    Which reservation or urban area:

    How many members are in your household:

    Adults (18+)

    Youth (13-17)

    Children (0-12)


    My most urgent need(s) are: Information regarding housing or employmentInformation regarding K-12 schools or collegesConnection to agencies which provide financial assistanceSocial connection to other Native individuals and familiesOther (please describe)


    Additional Comments