Application Forms
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Address Change Form (Health Care Coverage)
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Change of Aboriginal Status (Health Care Coverage)
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Name Change Form (Health Care Coverage)
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Non Insured Health Benefits (Health Canada)
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Temporary Absence Form (Health Care Coverage)
| Note: | Bursary forms for students pursuing careers in health and social services are available online. For more information on these bursaries and other forms of student support, see section on HSS Careers. |
Address Change Form (Health Care Coverage)
- English (PDF - 112.53 KB)
Adoption Registry - Application for Information
- English (PDF - 42.21 KB)
Application for Birth/Marriage/Death Certificate
- English (PDF - 174.55 KB)
Please note that we now accept Visa or MasterCard for payment. When you fax us your application, you can now call us with your credit card information. Also, please note that the "date of registration" and "registration number" asked for on the application is not required as this is for office use only.
Please note that for the Death Certificate, we only provide the paper certificate.
Birth, Death and Marriage Certificates are printed every Thursday.
Application for Métis Health Benefits
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English (PDF - 111.70 KB)
Note: Paper size is 8.5" by 14".3
Change of Aboriginal Status (Health Care Coverage)
- English (PDF - 122.71 KB)
Extended Health Benefits (EHB)
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EHB Additional Assistance Claim (PDF - 94.86 KB)
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EHB Application (English/French) (PDF - 92 KB)
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EHB Expense Claim (PDF - 79.29 KB)
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EHB Prior Approval Form for Equipment/Appliance for Program Clients (PDF - 54.96 KB)
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EHB Request for Exception Drug Coverage (PDF - 62.29 KB)
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EHB Seniors Program Application (PDF - 82.2 KB)
EHB payments are processed within 20 working days of the receipt date pending all required documentation.
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Application Form (PDF - 163.64 KB)
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Criteria and Guidelines (PDF - 186.56 KB)
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Health Promotion Strategy (HTML)
One-year community based project funding is available to a maximum of $10,000 per project during the 2006/2007 fiscal year, on a first come first served proposal submission basis. The Health Promotion Fund will provide funding to time-limited projects that address the priority areas listed in the Health Promotion Strategy.
Name Change Form (Health Care Coverage)
- English (PDF - 122.24 KB)
Non Insured Health Benefits (Health Canada)
Request for Health Care Coverage
- English (PDF - 142.4 KB)
Use the form below if you are new to the NWT and require an NWT health care card. Do not use this form to renew your current health care card - instead, contact the Health Services Administration Unit at 1-800-661-0830 for information on how to renew your health care card.
Temporary Absence Form (Health Care Coverage)
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English (PDF - 72.14 KB)
The Temporary Absence Form is to be completed if you will be out of the NWT for more than 3 months (90 days) for medical, work or school.
- Direct Deposit Form (Financial Management Board Secretariat)
On July 2, 2002 the Government of the Northwest Territories (GNWT) launched the Direct Deposit service to have payments deposited to Canadian bank accounts of businesses, government entities, individuals, organizations and students. Students who receive financial assistance from the HSS bursaries; and individuals who receive payment reimbursements from Extended Health Benefits program are eligible for the Direct Deposit service.
Through Direct Deposit, payees will receive money faster and with greater efficiency. This service is provided free of charge.
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Last Updated: November 10, 2006 |
