By DB program, I assume you mean defined benefit program? I don't think there is anything in the Act that states that you must be a member of a DB program in order to contribute money to a Roth under the Act, although I only skimmed the actual legislation. The money that is eligible for contribution is money that DID NOT go into your retirement account at your employer, anyway. The money that got distributed directly into your company's retirement plan is already tax deferred and is not eligible.
You don't necessarily need Form 8935 to contribute to a Roth under the Act. If you received money from a stock distribution and/or a bond distribution due to NWA's bankruptcy that wasn't contributed to your employer's plan, that amount is eligible for contribution to a Roth. Vanguard or Fidelity (and I'm sure others) will open a Roth under the Act without Form 8935, with the correct amount to contribute under the Act being your responsibility. You can look on your old W2's from the appropriate years and you should see the amounts that are eligible.
You have 5 days left. If you're going to make a contribution, you have time, but not much. Hurry up!