To Elevate the Quality of Life of the People We Serve

 KANA Workforce Development Master Application

If you or someone you know needs assistance completing this online application, please reach out to Workforce Development via email at workforcedevelopment@kodiakhealthcare.org or by phone at 907-486-9879.

ELIGIBILITY REQUIREMENTS: Additional documents may be needed for program-specific assistance.

• Completed application (all sections satisfied)
• Provide proof of Alaska Native/American Indian status - Child Care Assistance based on child status
• Provide a copy of Driver’s License or Identification Card
• Reside in the Koniag Region (Akhiok, Karluk, Kodiak, Larsen Bay, Old Harbor, Ouzinkie, or Port Lions) - Akhiok and Port Lions Scholarship Applicants need not reside within the Koniag Region
• Selective Service Registration (for male applicants 18 years or over)

 

Please upload required documents here:

https://form.jotform.com/Workforce_Development_workforce/MasterApplicationUpload

 

APPLICATION AND ASSISTANCE PROCESS:

• Return completed Master Application with all required documents for processing
• Completed applications will be processed within 10 business days - you will receive notifications via phone, email, or mail
• Complete and return supplemental program application and documentation (if required)
• Schedule and attend an intake meeting with your Case Manager

Parent/Guardian signatures are required for non-emancipated youth under 18 years of age.

AGREEMENT AND UNDERSTANDING: (Please initial)

As a participant in the Workforce Development programs, I understand and agree to the following:

• I understand that a Workforce Development staff member and I will develop a Self-Sufficiency Plan, which will outline my plan and necessary steps to achieve my goals and become self-sufficient.

• I will provide all additional information and/or documents requested by Workforce Development staff in order to verify my eligibility in the program and to help build and maintain my Self-Sufficiency Plan.

• I will take the necessary steps to achieve my goals included in my Self-Sufficiency Plan, with guidance from Workforce Development staff.

• I will attend all scheduled meetings to the best of my ability. If I cannot attend the meeting, I will provide advance notice and work with program staff to reschedule the meeting as soon as possible.

• I understand that Workforce Development may collect and/or verify information with tribal partners and local, state, and federal agencies.

• I understand my personal information will be treated in a confidential manner, and that KANA cannot disclose any information obtained during my application and program involvement unless I provide written consent, except as provided by law.

• I will be treated with respect and dignity by Workforce Development staff, and I will also treat staff with respect to ensure personal safety of all. I understand that if threats of any kind are made to Workforce Development staff, the department has the right to refuse and/or terminate services.

• I have received a copy of, and understand, my rights in the Workforce Development Appeals Process.

• I certify that the information I provided in this application is true and correct to the best of my knowledge, and I understand that I must continue to provide accurate and complete information to Workforce Development staff throughout my participation in the program.

AUTHORIZATION FOR RELEASE OF INFORMATION:

We may need to contact persons or organizations that can verify your information to determine your eligibility and/or for aligning services. When we contact such persons or organizations, we tell them our name, title, and that we work for Kodiak Area Native Association. We are prohibited by law from telling them anything about you or about the nature of services you are receiving that are outside of this release. The information we most often need to verify entails Tribal Enrollment or Native lineage, your household's composition, including income and resources, and to establish case and service collaboration among the below listed service entities.

Please type initials under the person/organization you authorize to release information:

Person/Organization Receiving Information:
KANA Workforce Development
3449 E Rezanof Drive, Kodiak, AK 99615
Phone Number: (907) 486-9879

Please type initials under the information you authorize to release:

I hereby authorize the use or disclosure of my family's health care and/or other information as described above. I understand that this authorization is voluntary and that I may revoke this authorization at any time by providing written notification to cancel or to change it. This authorization is valid for 12 months following the date of signature unless I revoke the form sooner following the above procedure. I understand that Workforce Development services are funded by state and federal grants, and that the state, federal, and lead agencies assure that the information received is treated as confidential and is protected in accordance with applicable state and federal laws. I understand that if the person or entity that receives the information being used/disclosed may not be a healthcare provider or health plan covered by federal privacy regulations, the information may be subject to redisclosure and no longer protected by these regulations.

APPLICANT APPEAL PROCESS FOR WORKFORCE DEVELOPMENT:

An applicant has the right to appeal any decision made by Workforce Development regarding their services. The appeal process is to be conducted in writing and within the specified time frames. An applicant may withdraw their appeal at any point during the four-step process detailed below.

Client Assistance Program (CAP) is a client advocacy organization that may be contacted at any time for assistance and/or support. For more information call 1-800-478-0047.

Step 1: Participant

Participant's must provide a written complaint to the Program Manager within five business days of the unsatisfactory decision. Complaints must include details and the desired action or remedy.

Step 2: Program Manager

The Program Manager has five business days to meet with and respond to the participant's complaint.

If the grievance is not resolved during the meeting with the Program Manager the participant may proceed to Step 3.

Step 3: Grievance Committee

Should the participant be unsatisfied with the determination made by the Program Manager the participant must submit a written complaint within 5 business days of the Program Manager's response. Once the written complaint is received a Grievance Committee will convene.

The Grievance Committee has five business days to meet and respond to the participant's complaint.

The decision of the committee will be the final within the Kodiak Area Native Association.

Step 4: U.S. Department of the Interior

Should the participant be unsatisfied with the final decision made by the Grievance Committee, the participant has the right to file a fully documented grievance to the Secretary of the Interior through the Division of Workforce Development.

U.S. Department of the Interior
1849 Constitution Ave. NW
Washington, DC 20245