Knik Social Services Intake

Knik Tribe Social Services Intake Form

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:

If you are an enrolled member of the Knik Tribe, please enter your information below to look up your Tribal Member information. If you are not a member, click the Next button to skip this step.

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

You must provide back up documents for all sources of income listed. For Youth Programs income verification information is ONLY to determine which funding source we will use for your student and in NO WAY affects their eligibility.

Household Size:

* Sources of Income and Amount:

* Annual Employment Income/Amount:
* Annual Child Support Amount:
* Annual Dividend Amount:

* Annual Corporation Shares Income/Amount:
* Annual Unemployment Amount:
* Annual Cash Assistance Amount (GA/TANF/SSI/FS):

* Current Needs:

Employment
Higher Ed
Training
CTE
Child Care
Youth Services
Education Needs
Youth RYS Program

Family Support/Assistance
Foster Care/Family Contact
Shan Qayeh (Fish Camp)

Domestic Violence Support
DEC KT
Human Trafficking
DEC Pass-Through
Juvenile Re-Entry
Housing

Elders Support

Please describe a brief summary of needs:

Document Upload

Please upload Driver's License, CIB, Employment and Income Verification Documents.

Click "Choose Files" again to add more files

Selected Files:

No files selected

Document Upload

Please upload Driver's License, CIB, Employment and Income Verification Documents.

Click "Choose Files" again to add more files

Selected Files:

No files selected

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: