HAF Application for Assistance

AVCP Regional Housing Authority Homeowner Assistance Fund Program Application for Assistance

Phone: (907)543-1337

Email: nandrew@avcphousing.org
Before you start this application

Required Documents for Each Adult in Your Household
Please have the following documents for every adult living in your household:
- Most recent IRS Form 1040 (Tax Return)
- W-2 Forms
- Recent Paycheck Stubs
- Any applicable 1099 Forms
- Social Security Income (SSI or SSA) documentation
Be sure to submit all applicable documents to complete your application. If you have any questions, please call (907)543-1337
1. Applicant Information
Name*
Address*

Mailing Address

Street Address Line 2

Physical AddressState / Province

City, State, Zip
Landline or Cell Phone Number
Please enter a valid phone number.
Email Address
example@example.com
2. Tribal Affiliation
Name of Tribe*
Tribe Address*

Mailing Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code
Are you enrolled with Calista?

YesNo
3. Mortgage Information

Fill if you currently have a mortgage for your home
Name of Bank or Institution
Address

Mailing Address

Street Address Line 2

City. State and ZipState / Province

Postal / Zip Code
4. If you currently don't have a mortgage
Are you the homeowner?*

YesNo
Who is the homeowner?
5. Utility Providers Information
Utility Assistance Information*
6. Family Composition and Income Information
Family Composition*
Required Documents for Each Adult in Your Household:
Please submit the following documents for every adult living in your household:
- Most recent IRS Form 1040 (Tax Return)
- W-2 Forms
- Recent Paycheck Stubs
- Any applicable 1099 Forms
- Social Security Income (SSI or SSA) documentation
Be sure to submit all applicable documents to complete your application.
Please include ALL 1040s, W2s, Paystubs, 1099, SSI, or SSA for ALL ADULTS (You can attach more than one file at a time)*

Cancelof
Having issues with uploading files? Try this:

🖥️ For Computer (Windows / Mac)
1. Click the “Browse Files” or “Upload” button.
2. In the file picker window:
  - Windows: Hold Ctrl (or Cmd on Mac) and click on each file you want to upload.
  - Or drag and drop multiple files directly into the upload area (if enabled).
3. Wait for each file to fully upload (you’ll see a progress bar or confirmation).
  Once uploaded, complete and submit the form.
📱 For Mobile Devices (iOS / Android)
1. Choose:
  - Files from your device
  - Or Browse to find files in cloud storage (Google Drive, iCloud, etc.)
2. To upload more than one file:
  - On iPhone/iPad:
    
    Tap “Browse”, go to the folder, then tap “Select” in the top corner, and tap multiple files.
  - On Android:
    
    Long-press the first file, then tap others to select them.
    
    Confirm your selection.
    
    Wait for all files to upload.
    
    Then submit the form.
Explain the nature or the kind of financial hardship you are experiencing? (Like job loss, only working part-time, increased costs, caring for a family member, etc.)*
If needed, what kind of work or improvement is needed to be done to your home?*
Check box(es) that apply to your request*

Material Reduction in incomeMortage Delinquency/DefaultForeclosureHome InsuranceLoss of UtilitiesLoss of Home Energy ServicesDisplacement of homeownerRehabilation/Modernization/WeatherizationArreages of Qualified ExpensesCare for Family Member
Statement/Bills

Mortgage StatementHome Insurance StatementHeating Fuel BillElectric BillWater/Sewer BillGarbage Bill
CERTIFICATION
I certify that the information provided to the AVCP Regional Housing Authority for the Homeowner Assistance Fund Program on household composition, income, and qualifiers are accurate and complete to the best of my knowledge and belief. I understand that false statements or information are punishable under federal law. I also understand false statements or information are grounds for termination of the Homeowner Assistance Fund Program. My household has not received any Homeowner Assistance Fund assistance from another organization.*
Full Name
Please Sign*

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Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

1. Applicant Information

2. Tribal Affiliation

3. Mortgage Information

4. If you currently don't have a mortgage

5. Utility Providers Information

6. Family Composition and Income Information

CERTIFICATION