Piikani Money Campaign Final Assessment Form and Consent

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Piikani Money Campaign Final Assessment Consent Form

The Piikani Money Campaign is a program that was conducted on behalf of a coalition, comprised of several organizations, institutions and Blackfeet tribal agencies. The purpose of the campaign was to provide urgently needed information about financial and predatory practices to enrolled tribal members who received offers and potential payments from the Federal Land Buy Back program in late 2016. 

The final assessment on the following pages is for the Piikani Money Campaign to gauge how the campaign has impacted tribal members’ financial decisions regarding Land Buy Back one-time payments.


Your name will not be connected to the final assessment responses, so your personal identity will remain anonymous. No one will be able to link you to the responses that you make.


Your participation in this final assessment is voluntary and you are not required to participate.


Your responses will help determine the effectiveness of the Piikani Money Campaign with regards to how it has provided education and financial awareness for tribal members to make healthy economic decisions.


There are no known negative effects for taking part in the survey.


If you want to be eligible for a new iPad, you must fill in ALL the information below and include it when you mail in the final assessment or if you fill out the final assessment online fill this form out online as well. You will only be eligible for the new iPad if you complete the entire survey. If you do not want to be eligible for the iPad, and want to remain anonymous, check a box below and continue with the final assessment.

For online use: By affixing a Guardian's name to this form it certifies that a guardian's permission was obtained at the time this survey was completed by the participant under the guardian's care.  Guardian's full name MUST be provided if the "Under 18" option for consent has been selected. Please type the guardian's full name on the line below.

Piikani Money Campaign Final Assessment

General Information

How many people are part of YOUR household?
"Household" includes anyone you share income and expenses with including: 1) your financial dependents (for example, your dependent children); 2) anyone you depend on financially (for example, your parents); and 30 anyone you are financially interdependent with (for example, your spouse or partner). Your "household" may or may not be the same as the people you live with.


Land Buy Back


Business Information