Knik 477 Intake

Knik Tribe

Welcome to the Knik Tribe Social Services Intake Application

A Knik Tribe Program

Please use a Chrome browser to complete this application.

All items must be completed

Please click the New Intake button to start the application process, or press the Upload Documents button to add documents to an existing application.

The online application must be completed and submitted.

* - Required field

* Previous Application ID:

* Last Name:

Enrollment ID:

Date of Birth:

Applicant Info

* Participant First Name:

Participant Middle Name:

* Participant Last Name:

* Date of Birth:

Spouse Name:

Physical Address:

City:

State:

Zip:

Phone Number:

Email:

Emergency Contact:

* Gender:
Male
Female
Other

* Veteran?
Veteran
Transitioning Service Member
Campaign Veteran
Disabled Veteran
N/A

* Education:
In-school, Alternative school or GED
In-school, Post H.S.
In-school, H.S. or less
Not Attending School, H.S. Dropout
Not Attending School, H.S., GED Graduate

* Employment?
Employed
Employed, but received termination notice or military separation
Not Employed or Not in Military

Marital Status:
Married
Co-habituating
Divorced
Never Married
Separated
Widowed

Do you have a child?
YesNumber of Children: No

Are you pregnant?
Yes No

Do you have a CIB?
Yes No

Are you involved with OCS?
Yes No

Alaskan Native/American Indian:
Yes No

Enrollment Number:

English Fluency

Excellent Good Moderate Poor Not at all

Income & Needs

Sources of Income and Amount:

Employment:
Child Support:
Dividends:

Corporation Shares:
Unemployment:
Cash Assistance:

* Current Needs (Select up to three):

Employment
Higher Ed
Training

CTE
Child Care
Youth Services

Housing
Family Support/Assistance
Domestic Violence Support

Education Needs
Elders Support
Foster Care/Family Contact

DEC KT
ICWA Support (OCS Involvement)
Human Trafficking

DEC Pass-Through

Please describe a brief summary of needs:

Document Upload

Selected Files:

Document Upload

Selected Files:

Signature Certification

By entering my name in the box below I certify that all information is correct and accurate to the best of my knowledge.

* Signature: