NV Georgetown Housing assistance form 2024

2024 Housing Assistance Application

Full Member Name*

Address*

Mailing address

Street Address Line 2

City/State/Zip

Email address

example@example.com

Phone number*

Enrollment number

The assistance will be used for a one-time payment per household of:

Mortgage assistance up to $1000
Rental assistance up to $1000
Dorm rent for Secondary Education up to $1000

The assistance will be paid to the landlord or mortgage company.

Indicate where grant award you wish to apply for on behalf of your household.

Landlord Information (rent or dorm)

Name

Address

City/State/Zip

Account #/Name

Mortgage Company

Name

Address

City/State/Zip

Account #

Send in a copy of one of the following:

Copy of the rental agreement or dorm rental
Copy of monthly rental or dorm bill
Copy of monthly mortgage bill

Certifications

I certify the COVID-19 public health emergency has impacted me.

Initial*

I certify that I have not applied for a similar program.

Initial*

I certify that I am the only member of my household that can apply.

Initial*

*Please note: This Assistance program is only open to NVG members**

NVG recognizes the need to support tribal members due to the COVID-19 public health pandemic. The individual assistance is aimed to help NVG members economically impacted by the COVID-19 public health emergency; by applying, there is no guarantee or obligation that funds will be awarded. The application will be kept confidential and remain within the NVG. Please answer each question to the best of your knowledge.

Applications may be submitted by email to Info@georgetowntc.com ,hand-delivered or mailed to the address below. Incomplete applications will be rejected. Applicants will be notified of the status of their application via email to the contact person listed on the application. The applicant's sole responsibility is to determine or seek independent advice on the tax implications of receiving the funds.

Native Village of Georgetown

5313 Arctic Blvd, Ste 104

Anchorage, AK 99518

I certify that the information provided in this application is true and accurate. I agree to verify the information provided in this application and to provide additional information to NVG if requested.

Signed*

Date*

Date

Print Name*