FORMS

Health, Registration, etc

APPLYING FOR CITIZENSHIP
All applicants are required to submit and Enrollment Application Form for consideration.

Printed applications can be obtained at your nearest Métis Council office. Individuals requiring assistance in completing the application can contact your nearest Northwest Territory Métis Nation Community Fieldworker.

Completed applications can be delivered to the Northwest Territory Métis Nation for review by any method noted on the Application Form. 

FORMS
Please review the below Enrolment Application Form to register for enumeration:

ONLINE – Membership Form

 

Part 1 – Membership Application Form (Fillable PDF)
Part 2 – GNWT Vital Stats Form
Part 3 – RC Diocese Personal Release Form
Part 4 – Membership Card Application Form

How-To: Provide your own photo and signature

REGISTRY OFFICE CONTACT INFORMATION
Northwest Territory Métis Nation Registry Office
Box 720
Fort Smith, NT
X0E 0P0
Phone: (867) 872-2770
Fax: (867) 872-2772

Métis Health Benefits Application Form

The Métis Health Benefits Application is intended for people registered to a Métis Community Council of the Northwest Territory Métis Nation who have not claimed Métis Health Benefits before. Applicants will also need to include a letter of current membership from their respective Métis Council President. Applicants may also be asked to provide the genealogy chart from the registration questionnaire to show a lineage or link to their family that were either born or resided in the Mackenzie Basin, North of the 60th parallel before January 1, 1921.

Request for Health Care Coverage Form

This form is for residents that are new to the NWT, including newborns and returning residents that have had health care cards in a different province.

Application for Birth, Marriage or Death Certificates

Temporary Absence Form

Temporary Absence applies to all NWT residents/people who are travelling outside of the NWT for long durations. This is particularly important for permanent residents of the NWT that plan to attend school outside of the Northwest Territories for longer than three months. Please fax a copy to Health Services Administration in Inuvik (867) 777-3197 before leaving the NWT, and keep a copy with you. It is very important to pay into school health insurance when asked. If one chooses not to pay into it, their health care benefits may be cancelled at such time for the duration of their school.

Consent to Disclosure Form

If you are looking for more assistance, you will need to complete a Consent to the Disclosure of Personal Information form in order for us to assist on your behalf.

Blue Cross Health Benefits Claim Form

The Health Benefits Claim Form is for Alberta Blue Cross card holders that have paid for health services (such as prescriptions, medical supplies, glasses) and are looking for reimbursement.

Métis Health Benefits Policy Criteria

Policy criteria for those who are eligible to apply for the Métis Health Benefits.

Care Card Renewal Form