Pre Screening Questionnaire
Are you a member of the following? Citizen of the Pokagon Band of Potawatomi Indians Citizen of Gun Lake Tribe Citizen of the Little River Band of Ottawa Indians Citizen of Nottawaseppi Band of Potawatomi Indians employee of Pokagon Band Tribal Government employee of Tribal enterprise employee of Four Winds Casino Resort (Employees must have 12 consecutive months of employment)
Yes
No
Thank you for your interest in Chi Ishobak's Consumer Loan Program. Unfortunately, this is an eligibility hard stop. You may contact us at (269) 783-4157 or info@chiishobak.org for further clarification.
Is the applicant at least 18 years old?
Yes
No
Thank you for your interest in Chi Ishobak's Consumer Loan Program. Unfortunately, this is an eligibility hard stop. You may contact us at (269) 783-4157 or info@chiishobak.org for further clarification.
Has the applicant had a bankruptcy within the last two years?
Yes
No
Thank you for your interest in Chi Ishobak's Consumer Loan Program. Unfortunately, this is an eligibility hard stop. You may contact us at (269) 783-4157 or info@chiishobak.org for further clarification.
Let's Get Started
Applicant
First name
Middle name
Last Name
SSN
Race
American Indian
Asian
Black Or African American
Hispanic
Multi-racial
Native Alaskan
Native Hawaiian
Other
Pacific Islander
Unknown
White
Gender
Female
Male
Other
Unknown
Urban/Rural
Non-Urban
Rural
Suburban
Unknown
Urban
Generation code
Junior
Senior
II
III
IV
V
VI
VII
VIII
IX
Date of birth
Honorific (Mr/Ms)
Contact Information
Applicant Address
Street1
Street2
City
State
Zip
Email
Phone
Website
Loan application
Amount requested
Financing Purpose
Automobile Purchase
Automobile Refinance
Automobile Repair
Personal
Referral Source
Website
Social Media
Newsletter
Word of Mouth
Tribal
Other
Comment