TNHA Housing Programs Application

Office Use Only

To be completed by TNHA Staff to record eligibility after application review. Date and time are to be completed only after complete application is received. Incomplete applications cannot be processed.
Dated completed application, including supporting documents, was received:

MonthDayYear
Date
Time completed application was received:

Hour Minutes

AM/PM Option
Application type?

OriginalUpdate
What village is application for? Use 3-letter code.
How many household members?
Bedrooms needed based on family size (typically up to 2 people per bedroom)
Eligibility Review

Application is completePassed background checkReferences checked: personal, credit, landlordNo monies owed to TNHA, verify all adult household membersIncome verification completed:
Total Household income minus any allowable deductions (up to $2,000 of ANSCA dividends per recipient, dependent deduction, etc.)
HUD Low-income Limit for household size:
Fair Market minimum income requirement based on bedroom size:
Eligibility determination:

Low RentFair Market RentHomebuyer - Currently limited to lease assumptionsTenant Based Rental Assistance - (TBRA) for private landlord rental subsidyPriority Placement - ensure form is completed, with all signatures and in applicant folderIneligible
Required Documents (check when received):

Completed ApplicationPayroll stubs (30 days) or employment termination (all adults)Photo ID(s) for all adultsOther
Additional Documents - limited to income-based programs (Check when received):

Copy of ANSCA Corporation Shareholder card or BIA CardSocial Security Cards (anyone over age 6)ANSCA dividend(s) statement – most recent 12 monthsIncome Tax returns, 3 years, with W-2 Tax DocumentsBank Statement (Savings, checking, IRA, Cert. of Deposit)Child Support or Alimony receivedPublic assistance, most recent determinationUnemployment compensation check receivedSocial Security Benefits receivedRetirement Payments (Employer Savings, Thrift, 401K, PERS)Childcare Expenses paid with name and address of provider(s)Alaska National Guard or Veterans BenefitsAnnuity Benefit or Insurance receivedBonus payment amounts received in the last 12 monthsHonoraria of the amount received for meetings attendedInterest payments receivedRental income received and name and address of renterTax Assessment of real estate (Land/Buildings)Tax Statement for Business ownedHandicapped assistance and medical expenses (exceeding 3% annual income) not covered by insuranceAny other income not listed (babysitting, stocks, bonds, etc)
Processing Staff Name
Instructions for completing TNHA Housing Programs Application:

HS-FRM-0011
1. Complete all fields. Use “N/A” for fields that do not apply to your family.

2. Additional pages may be attached for household information that exceeds the space allowed.

3. Use the checklist to gather required documents and additional documents as applicable.

4. Once complete, submit application and documents to: TNHA, PO Box 409, Utqiaġvik, AK 99723 or Housingservices@TNHA.net

5. Incomplete applications will not be processed.

PROGRAM(S)
FAIR MARKET RENTALS (Utqiagvik only)
- Open to general public
- Household income must be high enough that monthly rental rate does not exceed 30% of your monthly household income
- Utilities not included
- Security deposit is 2x monthly rental rate
LOW-INCOME RENTALS (LR)
- Available in Utqiagvik and Point Lay
- Rental program available to low-income American Indians/Alaskan Natives (AIAN)
- Rental rates are based on 30% of household income
- Annual income verification required
- Utilities not included
- $500 security deposit required
TENANT-BASED RENTAL ASSISTANCE (TBRA)
- Rental assistance available for low-income AIANs
- With approved landlord agreement, TNHA will subsidize your monthly rental payments
- Limited to TNHA service area
- Annual approval and income verification required
- Rental rates limited to HUD Fair Market Rates
HOMEBUYER
- Waitlist is closed
- Voluntary assumption of existing contract only
- Must be Low-income
- Limited to AIANs
- Annual income verification required
Select program(s) you are applying for.*

FAIR MARKET RENTALS (Utqigavik only)LOW-INCOME RENTALS (LR) - choose Utqiagvik or Point Lay belowUtqiagvik Low-income RentalsPoint Lay Low-income Rentals (Waitlist open until July 31, 2025)TENANT-BASED RENTAL ASSISTANCEHOMEBUYERUNSURE

REQUIRED DOCUMENTS (applicable to all TNHA programs)
All household adults must submit the following:
- Completed Application
- Payroll Stubs (30-days) or Employment Termination Notice
- Photo IDs
Upload required documents (listed above).*

Application cannot be processed until these are received.
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ADDITIONAL DOCUMENTS (required for income-based programs)
Bolded items listed below are the most commonly received by all applicants. The remaining are less likely, but please verify if they apply to your household before submitting your application.
- Copy of ANSCA Corporation Shareholder card or BIA Card
- Social Security Cards (anyone over age 6)
- ANSCA dividend(s) statement – most recent 12 months
- Income Tax returns, 3 years, with W-2 Tax Documents
- Bank Statement (Savings, checking, IRA, Cert. of Deposit)
- Child Support or Alimony received
- Public assistance, most recent determination
- Unemployment compensation check received
- Social Security Benefits received
- Retirement Payments (Employer Savings, Thrift, 401K, PERS)
- Childcare Expenses paid with name and address of provider(s)
- Alaska National Guard or Veterans Benefits
- Annuity Benefit or Insurance received
- Bonus payment amounts received in the last 12 months
- Honoraria of the amount received for meetings attended
- Interest payments received
- Rental income received and name and address of renter
- Tax Assessment of real estate (Land/Buildings)
- Tax Statement for Business owned
- Handicapped assistance and medical expenses (exceeding 3% annual income) not covered by insurance
- Any other income not listed (babysitting, stocks, bonds, etc.)
Upload applicable Additional Documents from the above list if you are applying for income-based programs. Your application is not complete until these are received.

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APPLICANT INFORMATION
Applicant Name (First Middle Last)*
Applicant Date of Birth*

MonthDayYear
Date
Applicant Social Security Number*
Applicant Primary Phone*
Applicant Alternate Phone*
Applicant Mailing Address (Street / PO Box, City, State Zip Code)*
Applicant Physical Address (Street / PO Box, City, State Zip Code)*
Applicant Email Address*
example@example.com
Applicant Years / Months at this address*
Applicant Monthly Rent or Mortgage*

CO-APPLICANT INFORMATION (if applicable)
Co-Applicant Name (First Middle Last)
Co-Applicant Date of Birth

MonthDayYear
Date
Co-Applicant Social Security Number
Co-Applicant Primary Phone
Co-Applicant Alternate Phone
Co-Applicant Mailing Address (Street / PO Box, City, State Zip Code)
Co-Applicant Email Address
Co-Applicant Physical Address (Street, City, State Zip Code)
Co-Applicant Years / Months at this address
Co-Applicant Monthly Rent or Mortgage
HOUSEHOLD COMPOSITION (List who will be living in the unit with the applicants)

OCCUPANT #1: Applicant
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
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Relationship to Applicant
Social Security Number*
Date of Birth

MonthDayYear
Date
Tribe, if applicable*
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):*

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #2: Co-Applicant or Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #3: Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #4: Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #5: Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #6: Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #7: Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

OCCUPANT #8: Other Member
Full Name
Disabled? ** (Check if yes)

Yes
Reasonable Accommodation Request, if applicable.

Please Include any applicable documentation. TNHA will consider all requests on a case-by-case basis.
Cancelof
Relationship to Applicant
Social Security Number
Date of Birth

MonthDayYear
Date
Tribe, if applicable
Required for NAHASDA, low-income programs
Income information and sources - 3 years of income taxes must be submitted with W-2s for all wages (check all that apply):

Files Income TaxesEmployedReceives PFD, even if it is garnishedReceives ANSCA dividendsReceives another type of income

EMERGENCY CONTACTS
Emergency Contact Name #1*
Address #1*
Phone Number #1*
Relationship to Applicant #1*
Emergency Contact Name #2
Address #2
Phone Number #2
Relationship to Applicant #2

EMPLOYMENT
Applicant Employer
Applicant Supervisor’s Name
Applicant Job Title
Applicant Net Monthly Income
Applicant Employer’s Address
Applicant Supervisor’s Phone
Applicant Years / Months Employed
Co-Applicant Employer
Co-Applicant Supervisor’s Name
Job Title
Net Monthly Income
Employer’s Address
Supervisor’s Phone
Years / Months

OTHER INCOME

OTHER INCOME

	Member Name	Received From	Contact Information	Monthly Amount
1.
2.
3.
4.
5.

REFERENCES AND LANDLORD HISTORY

REFERENCES (Credit and Personal Required)*

	Name of Reference	Mailing or Email Address	Phone Number	Relationship
1.
2.
3.

LANDLORD HISTORY (past 5 years)*

	Landlord Name	Mailing or Email Address	Phone Number	Move-in/Move-out Dates
1.
2.
3.

REQUIRED AUTHORIZATIONS
If I, or any member of my proposed household, have been required to register as a sex offender under AS 12.63.010, have been convicted of a felony, or are currently charged, I understand that TNHA may review relevant criminal records at its option. I agree to provide additional documents relating to convictions and to provide or sign additional releases, if needed, for TNHA to verify or research criminal history information.

I hereby authorize TNHA to inspect my current residential unit.

I hereby authorize TNHA to obtain a consumer credit report reflecting my credity history, through the Credit Bureau of Alaska.
I ________ authorize TNHA to contact my current Landlord.*

DODO NOT

CERTIFICATION STATEMENT
NOTICE: By signing this application, each person declares that all of the responses are true and complete and authorizes the Taġiuġmiullu Nunamiullu Housing Authority (TNHA) to verify information and obtain a copy of his or her credit report. Any false statement may result in the rejection of an application or immediate termination of a rental agreement.

Every adult eighteen (18) years and older, who will live in the residence, must furnish all applicable information and sign this application.
Applicant Signature*

Clear
Applicant Printed Name*
Date*

MonthDayYear
Date
Co-Applicant Signature

Clear
Co-Applicant Printed Name
Co-Applicant Date

MonthDayYear
Date
Co-Applicant #2 Signature

Clear
Co-Applicant #2 Printed Name
Co-Applicant #2 Date

MonthDayYear
Date
Co-Applicant #3 Signature

Clear
Co-Applicant #3 Printed Name
Co-Applicant #3 Date

MonthDayYear
Date
***Please notify TNHA in writing if any of the information on this application changes***

***Annual updates are required to remain on TNHA Waitlists. Failure to update will result in your removal from TNHA Waitlists.***

If you believe you have been discriminated against, or have questions about the laws regarding discrimination, contact the Alaska State Commission for Human Rights, at 1-800-478-4692.

Document No. HS-FRM-0011, Housing Programs Application, Rev 02 (07/01/2025)
LANDLORD VERIFICATION
LANLORD VERIFICATION

HS-FRM-0056

PART I - RELEASE OF TENANCY INFORMATION (to be completed by Applicant)
I, Applicant Name* , hereby authorize the following organization/landlord to release information concerning my rental history to:
Taġiuġmiullu Nunamiullu Housing Authority(TNHA)
PO Box 409Utqiaġvik, AK 99723
(907)852-7150
housingservices@tnha.net
Landlord Name (if no Landlord, list who you are currently staying with or a previous Landlord)*
Landlord Contact Email and/or Phone Number*
Rental Unit Street Address*
Landlord Verification - Applicant Signature*

Clear
Applicant Date*

MonthDayYear
Date

SUBMIT
Should be Empty:

Office Use Only

Instructions for completing TNHA Housing Programs Application:

HOUSEHOLD COMPOSITION (List who will be living in the unit with the applicants)

LANLORD VERIFICATION

Authorization for the Release of Information/Privacy Act Notice to the US Department of Housing and Urban Development and the Housing Agency/Authority (HA)