• Housing Assistance Application

    PO Box 1776, Petersburg, AK 99833
  •  -  - Pick a Date
  •  -  - Pick a Date
  • Household Income Information

    Include income for all household members
  • Vendor Information (Landlord, Utility Company)

    Payments will be sent directly to vendor
  • Signature Page

  • I understand that it is against the law to make false statements, and that I am subject to prosecution if I do.
    ▪ I authorize the release of information from my rental/utility vendor(s) to the
    Humanity In Progress (HIP) and further authorize the HIP to communicate with my vendor(s) on
    my behalf as it relates to the Assistance Program.
    ▪ I understand that my household can submit only "one" application for Assistance per program year and that the home I am applying for is the home I
    live in.
    I understand that HIP will confidentially use this information to provide improved
    services and acquire other grants. I certify that the information given above is true and complete to the best of my knowledge. I am signing knowing I am the designated representative of my whole household and this is the only application submitted for the members of this household. I understand that providing false or misleading information regarding anyone in my household is fraudulent and may be subject to criminal penalties.
    By signing, I certify that I have read and understand the above agreement.

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