KNIK TRIBAL COUNCIL

PO BOX 871565

WASILLA, AK 99687

Danielle Lind, Housing Manager / Shawna Theodore, Housing Assistant

Phone: (907) 373-7979 / (907) 373-7965

Fax: (907) 373-2178

HOUSING APPLICATION

Applications must be submitted with all required documents. It is applicant’s responsibility to obtain and provide all required documents. If not, application will be deemed “incomplete” and will not be considered. In this case, the application will be returned to the applicant. We do not archive ANY documents or verifications, including CIB from previous applications in prior years for re-use.

Giving false or incomplete information regarding applicant’s household income, composition, or other factors used to determine applicant’s eligibility is fraud. Any persons found guilty of fraudulent activity will not be eligible for further assistance and will be reported to the proper authorities.

Any accounts/bills that applicant requests assistance for MUST be in applicants name. Marriage certificates can be provided if account(s) is in spouse’s name.

All payments will be made directly to 3rd parties, not the applicant. Payment to related 3rd parties is strictly prohibited and can result in the loss of all future Housing Assistance at KTC.

Related third parties include: husband, wife, significant other, mother, father, brother, sister, uncle, aunt, cousin, child, grandparent, etc. Applying for assistance to 3rd parties will be considered fraud.

Applicant must meet all of the following eligibility requirements:

  • Verifiable income showing at or below the current 80% federal median income level for the Matanuska Susitna Borough.

2014 Income limits

1 Person / 2 Persons / 3 Persons / 4 Persons / 5 Persons / 6 Persons / 7 Persons / 8 Persons
44,000 / 50,250 / 56550 / 62,800 / 67,850 / 72,850 / 77,900 / 82,900
  • Alaskan Native or American Indian, please provide proof with CIB
  • In imminent danger of homelessness (using federal definition) or evidence of another verifiable housing emergency.

Only one individual in a household may participate in the program. Limits on amounts and frequency of assistance apply to entire household, not just the individual applying for assistance. KTC Housing Program staff shall maintain all eligibility documents in participant files for the current years funding.

All Eligibility determinations are based on need and will be evaluated case by case.

PLEASE BE ADVISED THAT A CRIMINAL BACKGROUND CHECK WILL BE CONDUCTED ON ALL ADULTS LISTED ON THIS APPLICATION FOR THE AFFORDABLE RENTAL PROGRAM AND WILL BE TAKEN INTO CONSIDERATION DURING THE SELECTION PROCESS FOR THE AFFORDABLE RENTAL PROGRAM.

Please check the program you wish to apply for.

EMERGENCY ASSISTANCE
Eligible households can apply for up to $1500 one time per year.
  • Rent/Eviction or First month’s rent
  • Foreclosure/Mortgage
  • Utilities (Gas & Electric)
  • Property Taxes Septic
  • Septic
  • Fuel Oil/ Stove Oil/Propane:
  • Wood
/ AFFORDABLE RENTAL PROGRAM
__2BDRM __3BDRM
Provide proof of the following if applicable:
  • Homeless
  • Involuntarily Displaced
  • Overcrowding
  • Paying over 50% of income for rent
  • Disabled / 55 years of age or older
  • Base /Voting /Enrolled Member
  • AK Native /American Indian living in the service area for 1 year

MODIFICATION REHAB PROGRAM
Maximum benefit is $20,000.
Eligibility for this program is once in a lifetime.
Provide proof of the following:
  • Ownership (deed/title)
  • Homeowners insurance
  • Current with Property Taxes
/ ELDER REHAB PROGRAM
Maximum benefit is $2000.
Eligibility is once every two years.
Provide proof of the following:
  • Disabled / 55 years of age or older
  • Proof of Ownership (deed/title)
  • Current with Property taxes

Housing Application Checklist

In order to be considered for the vacant unit, applicant is responsible for submittingall of the following:

☐Application form completely filled out and signed

☐Copy of government issued photo ID or driver’s license for all adult household members

☐Copy of CIB card of applicant

☐Copy of all children’s birth certificates

☐Social Security cards for all household members

☐APPLICANT is required to attach the following income documents (if applicable):

☐Previous years signed taxes

☐Employment Verification Form (if employed) or most recent paystub

☐Seasonal Income – Current tax form 1040

☐Self-Employment – Current tax 1040 and Schedule C, Form 1065, and Form 1120.

More documents may be required.

☐APA/ATAP/Alaska Senior Assistance – Printout from Agency

☐SSI/SDI/SSA – benefit award letter or proof of income

☐Unemployment – copy of award letter or proof of income

☐VA Pension

☐Worker’s Compensation – letter showing amount receiving

☐Alaska Native Dividends – letter or statement from Native Corporation showing amounts

received in the last 12 months.

☐Retirement and/or pension verifications

☐Monetary Support/Gift – self certification

☐Bank Statements for stocks, bonds, checking, savings, etc.

☐Notarized Statement of zero income

☐Other:

HOUSING APPLICATION

APPLICANT INFORMATION

Applicant Name:______Date:______

Home Phone #: ______Work/Cell# ______Email:______

Current Mailing Address:______

Current Physical Address: ______

HOUSEHOLD COMPOSITION – Please list all persons who will reside in your unit
Name / Relationship / Birthdate / Age / Social Security # / KTC Member #
Head
Co-head
3
4
5
6
7
8

Do you anticipate any changes to this household in the next twelve months?☐Yes☐No

If yes, please explain: ______

______

Are there any absent household members that are not listed in this application?☐Yes☐No

If yes, please explain: ______

Have you or has any other adult members of your household ever used any names other than the names listed on this application? ☐Yes ☐No

If yes, please explain: ______

Have you or has any other adult member of your household ever used any social security numbers other than the social security numbers listed on this application? ☐Yes ☐No

If yes, please explain: ______

Have you or anyone in your household ever been convicted of a crime other than a traffic violation?

☐Yes☐No If yes, please explain:______

______

SOURCES OF INCOME:

This section must be completed by all adult household members

INCOME – ALL amounts, monetary or not, that go to or are received on behalf of the family head, spouse or co-head (even if the family member is temporarily absent), or any other family member; and/or ALL amounts anticipated to be received from a source outside the family during the 12 month period following admission or annual re-certification effective date. This includes but is not limited to: Full and /or Part time employment, seasonal employment, welfare assistance, social security, pensions, SSI, disability, military pay/benefits, unemployment, child support, alimony, student grants/loans, self-employment, PFD, Native Dividends, income from sale of property, income trusts and any other income received from people not residing with you.

Head Applicant Name: / Co-Head Applicant Name: / Other Adult Applicant Name: / Other Adult Applicant Name:
Please Mark (X) YES or NO / Yes / No / Amount / Yes / No / Amount / Yes / No / Amount / Yes / No / Amount
Employment
APA/OAA/ATAP
Native Corporation Dividends
Unemployment
SSI/SSA
Veterans Benefit
Senior Assistance
Pensions/ Retirement
Rental Income
Child Support
Alimony
Monetary Gifts*
Claim zero income
Other:

*Includes rent and utility payments paid on behalf of family, and other cash or noncash contributions provided on a regular basis.

Applicant Name: / Applicant Name: / Applicant Name: / Applicant Name:
Employer Name:
Employer Phone:
Employer Fax:

Do all members in the household receive a PFD?☐Yes☐No(Mark “Yes” even if garnished)

If no, please explain who doesn’t and why: ______

______

Does anyone in the household anticipate gaining part or full time employment status within the next 12 months? ☐Yes ☐No Please explain why: ______

Briefly describe why you need assistance: ______

Please draw directions to your home:

DECLARATION

By signing this affordable rental housing application, the following is agreed to and understood:

Initial

_____KTC will verify that my family qualifies as low-income as described in the policy.

_____I (we) certify that the information provided in this application is accurate and complete to the best of my (our) knowledge.

_____I (we) understand that providing false statements or information is punishable under Federal Law and constitutes grounds for termination of housing assistance and eviction.

_____I (we) further certify that I (we) do not owe any money to any Indian Housing Office or Authority.

_____I (we) will be responsible for any damages made to the rental housing during my occupancy, if selected.

_____If selected, I (we) will be required to sign an Residential Rental Agreement prior to occupying a KTC rental unit and that it will be my (our) primary place of residence.

______

Signature of Head of HouseholdDate

______

Signature of Spouse/Co-TenantDate

Knik Tribal Council

Housing Programs

P.O. Box 871565

Wasilla, Alaska 99687

PH: 907 373-7979 / FX: 907 373-2178

E-mail:

______

RELEASE OF INFORMATION

I, ______, hereby authorize the release of any information concerning me, to the Knik Tribal Council Housing Programs, mailing address P.O. Box 871565, Wasilla, Alaska 99687. The requested information shall be used solely in the administration of KTC programs, and a reproduction of this release is as valid as the original. Contacts may include, but not be limited to:

Public Assistance

Department of Labor

Veterans Administration

Division of Vocational Rehabilitation (DVR)

Employers

Native Corporations

Bureau of Indian Affairs

Private Individuals

Alaska Perm. Dividend Fund

Alaska Longevity Fund

Other (Please Name): ______

This authority shall continue until revoked in writing by the undersigned.

______

Applicants Signature Date Social Security Number

______

Spouse/ Co- Habitant Signature Date Social Security Number

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