Rental Assistance Program Pre-Application

Rental Assistance Pre-Application
Ka Hale A Ke Ola Homeless Resource Center, Inc. (KHAKO) administers a Rental Assistance Program, funded by the County of Maui. This program provides eligible households with necessary assistance to mitigate evictions and homelessness throughout the County of Maui and may include households whose income was affected by COVID-19. As a requirement to administering these services, applicants must accurately complete this application. Any false or omitted information found may result in denied services.

Target Population:
✓Homeless
✓At-risk of Homelessness
✓Moving from emergency or transitional housing
INITIAL APPLICANT INTAKE
Please indicate if you have received rental assistance: (+ add more)*
Date of Application*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How Many Adults?*
How many children?*
Do you receive HUD?*

YesNo
Requested Assistance:*

RentSecurity DepositUtility Deposit
Eviction Notice Date:

MonthDayYear
Date
Eviction Date:

MonthDayYear
Date
What is your total annual household income?*
What is your total monthly household expenses?*
PROGRAM CHECKLIST

Required Documents
The following list is all the requirements needed for approval. Please provide information for ALL household members. Once a Rental Assistance Coordinator reviews your application they will contact you to verify any missing items.

Identification:
- Photo Identification of all household members 18 years+Driver’s License or State ID
- Non USA citizens must provide passport
- Social Security Numbers and Birth Date of all household members
- Birth Certificate for only household members 5 years and younger
Income Verification: (must be dated within 30 days of application for all verifications)
- Most current pay stubs covering the 30 days before the date of application
- Social Security Statement of Benefit/Pension
- Supplemental Social Security Income
- Unemployment Benefit Statement
- Monthly/quarterly financial statement; and G.E.T. if self-employed
- DHS Notice for Financial or Food Stamps TANF/SNAP (Benefit History printed within 30 days)
- Income Tax Returns
- Receipts showing how tax refunds were spent
- Income Tax Extension Letter
- Other (Child support, Alimony, etc.)
- COVID-19 income loss proof
Asset Verification:
- Current Checking Account Statement (within 30 days of application)
- Current Savings Account Statement (within 30 days of application)
- Other (Stocks, bonds, cash on hand, 401K, etc.)
Lease Verification:
- Copy of signed CURRENT lease or Unexecuted/Unsigned lease may be submitted if not currently living in the rental unit at the time of your rental application. However, check will not be released until submittal of signed lease.
- Utility Deposit Statement/Print Out from Utility Company
- W-9 Form with Landlord/Property Managers Signature
  - Landlord’s General Excise Tax Number (G.E.T.)
  - Tax Map Key (T.M.K.) Numbers Form
  - Rental Property Address
Back Rent/Eviction Verification:
- Letter from Public Housing, Landlord, Homeless or transitional shelter addressed to applicant
Letter must include the following:
- Date of Eviction Letter & Date applicant must vacate the premises
- Dates of unpaid rent with amounts & Breakdown of costs and total amount owing
- Printed name, contact number and Signature of evicting or current landlord
Other:
- Letter from applicant explaining why assistance is needed and/or why you are behind on rent
- Current Credit Report for all adults in the household (www.annualcreditreport.com)
- Mandatory Financial Literacy class to be attended
- Mandatory Unit Hygiene class to be attended
- Rental Subsidy Letter (HUD of DHS) – HUD Notice of Rent Adjustment
- Home Inspection from HUD (front page of House Inspection form indicting box, passed)
I, First Name Last Name (name) understand that this is a pre-application to determine program eligibility. I understand the documents that are required of me to apply for the rental program and I must be forthright and truthful with all information provided to include but not limited to, disclosing assistance received by any one of the following agencies within the past two years; Women Helping Women, Family Life Center, Maui Economic Opportunity, Catholic Charities. I also understand that I must schedule an appointment with KHAKO's Housing Specialist by the document due dateDate* once I have all required documents.
File Upload: You may upload any required documents here (see list above). Photos (jpg, jpeg, png) of documents or PDF scans are accepted. Please ensure any photos are clear and large enough to print clearly.

Cancelof
OFFER AND ACCEPTANCE OR WAIVER OF FREE INTERPRETER SERVICES
English is my primary language:*

YesNo
Do you need an interpreter?*

Yes - I want KHAKO to provide an interpreter at no cost to meYes, but - I do not want an interpreter provided by KHAKO, I will provide my ownNo, I do not need an interpreter
I need an interpreter for the following language:
Applicant Signature:

Clear
Please allow adequate time for review and someone will contact you whether you qualify or not.
Should be Empty:

Rental Assistance Pre-Application

INITIAL APPLICANT INTAKE

PROGRAM CHECKLIST

OFFER AND ACCEPTANCE OR WAIVER OF FREE INTERPRETER SERVICES

Please allow adequate time for review and someone will contact you whether you qualify or not.