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Student Rental Assistance Program Application

Student Rental Assistance Program ApplicationChristopher2022-03-02T22:26:27-09:00

Complete all sections, or indicate N/A if it doesn't apply. Contact KIHA's Housing Department if you have questions about the form or associated paperwork.

1Applicant Information
2School Information
3Sources of Financial Aid
4Housing Costs During the School Year
5Household Composition
6Household Income
7Assets
8Additional Information
9Notices and Disclosure Statements
Full legal name(Required)
Sex
Format xxx-xx-xxxx
MM slash DD slash YYYY
Are you a U.S. Citizen?(Required)
Are you a Native American(Required)
Marital Status(Required)

The Student Rental Assistance Program is for Alaska Native/American Indian applicants only. Please contact KIHA's Housing Department to inquire about housing programs for non-AIAN applicants.

Mailing Address(Required)
Physical Address
If different from mailing address.
Current landlord's name(Required)
Name of your nearest living relative(Required)
Anticipated or actual start date of the school you will attend.
MM slash DD slash YYYY
Anticipated end date of the school you will attend.
MM slash DD slash YYYY
Mailing address of the school(Required)
Physical address of the school(Required)

List ALL grants, scholarships, loans, gifts, or other financial aid you (the student) have received or will receive for this school year. Upload evidence of this assistance if available.

Example: grant, scholarship, gift, loan, etc.
Name of aid source(Required)
Example: grant, scholarship, gift, loan, etc.
Name of aid source
Example: grant, scholarship, gift, loan, etc.
Name of aid source
If you have additional sources of financial aid, upload a written statement. Upload evidence of all financial aid listed. If you are not able to upload supporting documents, you may email them or drop them off at one of our office locations.
Drop files here or
Accepted file types: jpg, pdf, gif, heic, Max. file size: 50 MB, Max. files: 5.
    Example: rent, shared rent, electric, heat, telephone, food, etc.
    Example: rent, shared rent, electric, heat, telephone, food, etc.
    Example: rent, shared rent, electric, heat, telephone, food, etc.
    If you have more anticipated monthly housing expenses, upload a written statement. Upload evidence of all monthly housing costs reported. If you are not able to upload supporting documents, you may email them or drop them off at one of our office locations.
    Drop files here or
    Accepted file types: jpg, pdf, heic, gif, Max. file size: 50 MB, Max. files: 5.

      List everyone who lives in your home, starting with yourself. If you are living with your parents or another adult family member, you must list them too. Upload additional written information if necessary.

      Name(Required)
      Applicant's date of birth
      MM slash DD slash YYYY
      Sex(Required)
      Format xxx-xx-xxxx
      Name
      MM slash DD slash YYYY
      Sex
      Format xxx-xx-xxxx
      Example: mother, father, daughter, son, mother-in-law, cousin, etc.
      Name
      MM slash DD slash YYYY
      Sex
      Format xxx-xx-xxxx
      Example: mother, father, daughter, son, mother-in-law, cousin, etc.
      Name
      MM slash DD slash YYYY
      Sex
      Format xxx-xx-xxxx
      Example: mother, father, daughter, son, mother-in-law, cousin, etc.
      Upload written information for any additional household members not included in the form fields above.
      Accepted file types: jpg, heic, pdf, gif, Max. file size: 50 MB.

      Federal laws require that you disclose all household income. Please list all GROSS income (prior to taxes or withholdings) for all family members listed in the previous section. This includes wages, government benefits such as Social Security, Unemployment, Senior Care, etc., child support income, Native or Indian Dividends, Alaska Permanent Fund Dividends, self-employment income, etc. You will be asked to provide documentation such as paystubs, tax returns, benefit statements, income tax returns, etc., and KIHA will verify the information provided. Parents' income need not be disclosed if the student has not lived with the parents for 12 months and is not claimed as a dependent on the parents' most recent tax return, or has been legally emancipated.

      Family member's name(Required)
      If self-employed, use "self-employment".
      Rate(Required)
      Frequency of work(Required)
      Family member's name
      If self-employed, use "self-employment".
      Rate
      Frequency of work
      Family member's name
      If self-employed, use "self-employment".
      Rate
      Frequency of work
      If you have additional sources of income to add, upload a written statement here. You must provide supporting documentation for all income sources listed. If you are not able to upload supporting documents, you may email them or drop them off at one of our office locations.
      Drop files here or
      Accepted file types: pdf, jpg, gif, heic, Max. file size: 50 MB, Max. files: 5.
        List everyone in your household who received an Alaska PFD last year, even if it was garnished. If everyone received a PFD, use "all". If no-one received a PFD, use "none".
        Do you receive child support income?(Required)
        Did you include the child support income in the form fields above?(Required)
        Leave blank if listing real property, a car, etc.
        Asset owner(Required)
        Name of native corporation, make and model of vehicle, bank where account is located, etc.
        Leave blank if listing real property, a car, etc.
        Asset owner
        Name of native corporation, make and model of vehicle, bank where account is located, etc.
        Leave blank if listing real property, a car, etc.
        Asset owner
        Name of native corporation, make and model of vehicle, bank where account is located, etc.
        Upload a written statement listing any assets not included in the form fields above. Include the type of asset, account number or number of shares, asset owner, estimated value, and location of the asset for each asset listed.
        Accepted file types: jpg, gif, pdf, heic, Max. file size: 50 MB.

        Please answer all of the following questions and provide detail as necessary. False or incomplete information may be considered fraud and carries serious consequences that can include fines or imprisonment.

        Have you or a member of your household ever been arrested, charged or convicted of any crime other than a traffic violation?(Required)
        Have you or a member of your household ever been evicted or had a lease terminated?(Required)
        Have you or a member of your household every participated in a federally subsidized housing program?(Required)
        MM slash DD slash YYYY
        MM slash DD slash YYYY
        Address of housing authority(Required)
        Do you or a member of your household owe money to a current or a past landlord, including any other housing agency or housing authhority?(Required)
        If you are age 62 or over, are disabled or handicapped, do you have medical expenses that are NOT reimbursed by insurance or other programs?(Required)
        If you have children under age 13, do you pay for childcare in order to work or attend school?(Required)
        Have you or any other member of your household sold, transferred, or given away any asset(s) in the past 24 months?(Required)
        Assets can include but are not limited to real estate, automobiles, bank accounts, cash, stock, etc.
        Max. file size: 50 MB.

        Our Privacy Policy


        We collect non-public personal information about you from the following sources:

        *Information we receive from you on applications or other forms;
        *Information about your transactions with us or others; and
        * Information we receive from others, such as a consumer reporting agency, court records, employers.

        We do not disclose non-public personal information about you to anyone, except as authorized by you or permitted by law.

        If you decide to close your account(s) or become an inactive client, we will adhere to the privacy policies and practices as described in this notice.

        To maintain security of client information, we restrict access to your personal and account information to those employees who need to know that information to provide you with our products and/or services. We maintain physical, electronic and procedural safeguards that comply with federal standards to guard your non-public personal information.

        Your confidence in us is important and we want you to know that your personal and account information is safe. If you have any questions or concerns, please contact us:

        Kodiak Island Housing Authority
        3137 Mill Bay Road Kodiak, AK 99615
        Telephone: (907) 486-8111 or Toll free: 1-(800) 478-5442 Fax: (907) 486-4432 or (907) 486-8723
        Website: www.kodiakislandhousing.org


        Privacy Act Notice


        This information is to be used by Kodiak Island Housing Authority (KIHA) in determining whether you qualify for its program(s), the recommended unit size, and the amount the participant must pay toward rent and utilities. It will not be disclosed outside KIHA except as required and permitted by law. You do not have to provide this information, but if you do not your application for approval or continuance may be delayed or rejected. The information used in this form is authorized by Title 38, USC, Chapter 37 (if VA), by 12 USC, Section 1701 et. seq. (if HUD/FHA); by 42 USC, Section 1452b (if HUD/CPD); and Title 42 USC, 1471 et. seq., or 7 USC, 1921 et. seq (if USDA).

        Equal Opportunity Notice


        Kodiak Island Housing Authority does not discriminate against any person because of race, color, religion, sex, handicap, familial status or national origin. We do business in accordance with the Federal Fair Housing Law.

        Notice Regarding Fair Housing


        If you believe you have been discriminated against you may contact the Fair Housing & Equal Opportunity Hot Line toll-free at 1-(800) 877-0246 or (206) 220-5170 or TTY (206) 220-5185, or write to: US Dept. of Housing & Urban Development Building 909 First Avenue, Room 205 Seattle, Wa. 98104-1000
        Certification & Authorization(Required)
        MM slash DD slash YYYY

        3137 Mill Bay Rd.

        Kodiak, Alaska 99615

        (907) 486-8111

        Contact us

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        AK Business License: 310841

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