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Missing & Murdered Diné Relatives Coalition (MMDRC) Aid/Assistance Request Form

MMDRC offers assistance with MMDR/MMIP event planning/coordination, limited financial assistance (pending available grant/donation funding), sharing MMDR/MMIP stories and flyers to social media, and so on to assist impacted MMDR families. The limited financial assistance assists families with various costs including funeral/burial assistance, search and rescue costs, MMDR/MMIP awareness/memorial events, flyer printing costs, MMDR/MMIP related travel, etc. Documentation including budgets, receipts, invoices/quotes, W-9 forms, and others may be requested depending on the request for grant reporting purposes.


We currently do not offer aid/assistance for personal bills (cell phone, wifi/internet, rent, etc.), lodging/gas money/food for non-MMDR related travel, and so on.


We do not have an estimated turnaround time as we are working with a small team located in multiple states and we receive various types of requests for assistance that require different processes. 'Ahxehee' and thank you for your patience and understanding. Please contact vangie@navajommdr.org and/or zunneh-bah@navajommdr.org for any questions.
* Date of request
0/500
* Full name of your missing and/or murdered relative (please also include any other legal names, nick names, maiden names, aliases, multiple last names, etc.)
0/500
* Request made by (enter your full name)
0/500
* Requester's relationship to missing and/or murdered relative
0/500
* Phone number
0/500
* Email address
0/500
* Family's primary point of contact (one person, please include contact information if the point of contact is different from the requester)
0/500
* Full name and relationship of the next of kin to your missing and/or murdered relative
0/500
* What is the current and/or past status of your relative? (Check all that apply)
* If you have a family advocate working with your family, please provide their full name and contact information
0/500
* Request details: please share below what type of assistance your family is in need of and how will this help your family
0/500
* Request details (enter N/A if not applicable): please share below if you have reached out to any other resources to request for assistance. If so, who and have you received any assistance from them? (This helps us consider other funding sources and additional resources that may be available to your family, please include the source and amount received)
0/500
* Request details (enter N/A if not applicable): if you are requesting financial assistance, please share below the amount you are requesting and if this is a payment you need assistance in covering in advance or if this will be a reimbursement to you
0/500
* For missing and/or murdered relatives: what tribal/county/state/federal jurisdiction(s) are handing the missing person's case? (examples: Navajo Police Department, Gallup Police, San Juan County Sheriff, FBI, etc.)
0/500
* For missing relatives (enter N/A if not applicable): what date were they last seen?
0/500
* For missing relatives (enter N/A if not applicable): where were they last seen and where were they reported missing?
0/500
* For missing relatives (enter N/A if not applicable): please share below if you need assistance with creating a Missing Person Flyer, printing the flyers, and/or sharing the flyer on social media
0/500
* For murdered relatives (enter N/A if not applicable): date of death and/or when the deceased was found
0/500
* For murdered relatives (enter N/A if not applicable): was this relative reported as missing prior to being found deceased?
* For murdered relatives (enter N/A if not applicable): please share the circumstances or cause of death, if known at this time (ex. murdered, suspected murder, accident, overdose or exposure, death by suicide, unknown, etc.). Collection of this data helps us advocate for resources and responses to the MMIP crisis, it also helps us determine what resources you're eligible to receive.
0/500
* For murdered relatives (enter N/A if not applicable): if requesting financial assistance related to a funeral/burial, please share the funeral home name and contact information
0/500
* For murdered relatives (enter N/A if not applicable): if requesting financial assistance related to a funeral/burial, please share the date of the burial or funeral (if known at this time)
0/500
* Please share if you have any additional information or questions that you would like us to know
0/500
Submit Online Request Form

MMDRC | 2418 E Hwy 66 #739 | Gallup, NM 87301 US

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