Apply for a NAHASDA-Assisted Rental or the Rental Assistance Program

Applicant Information (Head of Household)

Are you applying for an affordable rental unit or to receive rental assistance?(Required)

If accepted to the NAHASDA-Assisted Rental Program, you will be a tenant at a KIHA-owned rental property. In the Rental Assistance Program, you choose your own rental and KIHA provides assistance with rent payments.

KIHA-owned rental unit

Rental Assistance Program

Which properties are you interested in?(Required)

NAHASDA-Assisted Apartment in Kodiak

Elderly and/or Disabled Housing

Larsen Bay Rental Units

Ouzinkie Rental Units

Old Harbor Rental Units

What size unit are you requesting?(Required)

1-bedroom

2-bedroom

3-bedroom

4-bedroom

Are you requesting a unit with handicap accessibility features?

Yes

No

Full Legal Name(Required)

First Middle Last

Social Security Number(Required)

Format xxx-xx-xxxx

Sex(Required)

Female

Male

Date of Birth(Required)

Are you a U.S. Citizen?(Required)

Yes

No

Are you Native American?(Required)

Yes

No

The Rental Assistance Program is only for Alaska Native and American Indian (AI/AN) applicants. If you are not AI/AN, you are ineligible for this program.

Please call our Housing Department at (907) 486-8111 to ask about other program options.

Marital Status(Required)

Is your spouse the co-applicant?(Required)

Yes

No

N/A

Would you like to include a co-applicant on this application?(Required)

A co-applicant may be a significant other or partner with whom you share all household responsibilities.

Yes

No

Current Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Physical Residence Address

If different from current mailing address.

Street Address Address Line 2 City State ZIP Code

Daytime Phone(Required)

Cell Phone

If different from daytime phone.

Work Phone

If different from daytime phone.

Email Address

Name of Current Employer(Required)

Start Date(Required)

Employer's Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Employer's Phone Number(Required)

Employer's Fax Number

Employer's Email

Current Landlord's Name(Required)

Landlord's Phone Number(Required)

Name of Your Nearest Living Relative(Required)

Phone Number of Your Nearest Living Relative(Required)

List other names you have used in the past 10 years, including nicknames:

Will anyone else live in the home with you?(Required)

Yes

No

Co-Applicant Information

Full Legal Name(Required)

First Middle Last

Relationship to Applicant(Required)

Sex(Required)

Female

Male

Date of Birth(Required)

Are you a U.S. Citizen?(Required)

Yes

No

Are you a Native American?(Required)

Yes

No

Current Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Physical Residence Address

If different from mailing address.

Street Address Address Line 2 City State ZIP Code

Daytime Phone Number(Required)

Cell Phone Number

If different from daytime phone number.

Work Phone Number

If different from daytime phone number.

Email Address

Are you currently employed?(Required)

Yes

No

Name of Current Employer(Required)

Start Date(Required)

Employer's Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Employer's Phone Number(Required)

Employer's Fax Number

Employer's Email

Current Landlord's Name(Required)

Current Landlord's Phone Number(Required)

Name of Your Nearest Living Relative(Required)

Phone Number of Your Nearest Living Relative(Required)

List any other names you have used in the past 10 years, including nicknames

Household Income

Please indicate the gross monthly household income for ALL adult wage earners. Use the amount earned before taxes and other withholdings.

Household Member's Name(Required)

Amount Earned Per Month(Required)

Total amount before taxes and other withholdings.

Source of this Income(Required)

Wages, child support, public assistance, etc.

Household Member's Name

Amount Earned Per Month

Total amount before taxes and other withholdings.

Source of this Income

Wages, child support, public assistance, etc.

Household Member's Name

Amount Earned Per Month

Total amount before taxes and other withholdings.

Source of this Income

Wages, child support, public assistance, etc.

Other Household Income

Describe and provide detail for all other income, such as Alaska Permanent Fund Dividends, insurance settlements, unemployment compensation, worker's compensation, pension or retirement, etc.

Household Bank Accounts

Please list the bank and credit union accounts that belong to the adult household members. Upload additional written information if necessary.

Name of Bank or Credit Union(Required)

Type of Account(Required)

Checking

Savings

Account Number(Required)

Current Balance(Required)

Name of Bank or Credit Union

Type of Acount

Checking

Savings

Account Number

Current Balance

Name of Bank or Credit Union

Type of Account

Checking

Savings

Additional Bank Account Information

If you have more bank account information to add, please upload a written list.

Accepted file types: jpg, gif, pdf, png, Max. file size: 50 MB.

Employment Information

Please provide the following information regarding previous jobs you have had in the past 24 months. Include information for all adults in your household. If you were self-employed or unemployed during this time, please indicate this.

Name of Employer(Required)

Phone Number of Employer(Required)

Start Date(Required)

End Date(Required)

What was your name when you worked here?(Required)

Name of Employer

Phone Number of Employer

Start Date

End Date

What was your name when you worked here?

Name of Employer

Phone Number of Employer

Start Date

End Date

What was your name when you worked here?

Name of Employer

Phone Number of Employer

Start Date

End Date

What was your name when you worked here?

Additional Employment Information

If the adult members of your household had more than four employers over the last 24 months, please upload written information about all additional employers. Include self-employment and periods of unemployment.

Accepted file types: jpg, gif, png, pdf, heic, Max. file size: 50 MB.

Personal References

Provide the names and contact information for three people (not related to you) who can provide a personal reference for you.

Name(Required)

First Last

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Relationship to Applicant or Co-Applicant(Required)

Name(Required)

First Last

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Relationship to Applicant or Co-Applicant(Required)

Name(Required)

First Last

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Relationship to Applicant or Co-Applicant(Required)

NAHASDA-Assisted Rent and Rental Assistance Application Form

Applicant Information (Head of Household)

The Rental Assistance Program is only for Alaska Native and American Indian (AI/AN) applicants. If you are not AI/AN, you are ineligible for this program.

Please call our Housing Department at (907) 486-8111 to ask about other program options.

Co-Applicant Information

Other Household Members

Previous Addresses and Landlords

Household Income

Household Bank Accounts

Employment Information

Personal References

Additional Questions

Consent & Authorization

Declaration of Citizen or Non-Citizen Status

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