MANIILAQ ASSOCIATION EMPLOYMENT & TRAINING
EMERGENCY ASSISTANCE APPLICATION
Emergency Assistance
Eligibility Required Documents
Emergency Assistance is available to Tribal members from the
Maniilaq Service Area. Emergency Assistance payments can be
provided to individuals or families who suffer from a burnout,
flood, or other destruction of their home and loss or damage to
personal possessions. Emergency Assistance funds are for
essential needs and non-medical necessities. Emergency
Assistance funds cannot be used for transportation, home
evictions and /or cut off of fuel or utilities.
If approved the payment will not exceed the Emergency
Assistance payment standard of $1000 per household, per BIA
CFR§20.329 & 20.330.
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Prior to applying for Maniilaq Association Emergency
Assistance, you may contact the Red Cross of Alaska
at 1.800.451.8267 and request assistance.
Responsibility
To qualify you must:
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Be Tribally enrolled in one of the villages from the
Maniilaq service area;
Be a resident of the Maniilaq service area for 90 days with
the intent to remain in the region;
Not currently receiving any other public assistance
(ATAP, SSI, TANF); and
Income eligible, not enough resources to meet the
essential needs items.
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Complete, signed Emergency Assistance application
Tribal enrollment verification (IRA)
Valid State ID
Social Security Card
Proof of all sources of Income
Include a Statement of need in writing;
Proof of Emergency situation from City or IRA official
describing the incident;
Proof of residency, must reside in the Maniilaq Service Area
Applied for other assistance such as: Alaska Red Cross,
General Relief Assistance, Native Corporations, IRA,
Veterans benefits and any other agencies
Goals and Objectives
If your application is incomplete, we will contact you to inform
you of what’s needed, and you will have 30 days to get the
required information back to us. After the initial contact, it is the
applicant’s responsibility to contact the Maniilaq Employment &
Training office to ensure his/her application is complete.
Notice
Maniilaq Association Emergency Assistance Program, is not
automatic and is not an entitlement. You must apply, and
provide all documentation required. Emergency Assistance
applications are processed immediately upon receipt of all
required information.
The goal of the Emergency Assistance Program is to provide
relief and support to families who are not supported by their own
means, other public funds, or assistance programs.
READ
I/We apply for Emergency Assistance for the listed members of my (our) household who are in need.
I/We understand that:
1.
Applicants or recipients who knowingly and willfully provide false or fraudulent information are subject to prosecution
under 18 U.S.C. 1001, the Federal Law concerning fraud which carries a fine of not more than $10,000 or
imprisonment of not more than five years or both.
Initials of applicant___________
2.
I/We agree to supply information regarding resources and income and to notify Maniilaq E&T of any changes in my
(our) situation.
Initials of applicant___________
Submit Complete Applications to:
Maniilaq Association Employment & Training
P: (907) 442-7021 Fax: 1-866-832-9350
scholarships@maniilaq.org
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MANIILAQ ASSOCIATION EMPLOYMENT & TRAINING
EMERGENCY ASSISTANCE APPLICATION
Incomplete applications will be held for 30 days. If all requires documentation is not received within that time
period your application will be denied.
Applicant Information
Name:
First
Middle
Last
Social Security Number
Maiden Name: Or other Names Used:
Date of Birth:
Male
Mailing Address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Home Phone:
Veteran:
Message Phone:
Yes
No
Female
Email Address:
Registered with selective Services?
Yes
No
N/A
Tribal Village IRA you are enrolled in: _____________________________________________
Attach Copy of Tribal Card
Applicant Status:
Single
Married
Separated
Current Residency:
Own Home
Rent Home/Apartment
Divorced
With Relatives/friend
Widowed
Rent Room
Other: ___
Household Information
List all persons currently living permanently in the household with the information requested for each person (you,
spouse/significant other, children, parents, grandparents, aunts, uncles, etc.).
Name
Relationship to
Applicant
Self
Birth Date
Tribal Enrollment
Village
Social Security #
How many persons live in the house? _________Adults _________Children
Are you or any member of your household a shareholder of a Native Corporation?
If yes, list the names of household members and Corporation(s):
Native
# of
Name:
Name:
Corporation
Shares
Submit Complete Applications to:
Maniilaq Association Employment & Training
P: (907) 442-7021 Fax: 1-866-832-9350
scholarships@maniilaq.org
Yes
No
Native
Corporation
# of
Shares
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MANIILAQ ASSOCIATION EMPLOYMENT & TRAINING
EMERGENCY ASSISTANCE APPLICATION
Barriers to Self Sufficiency (Check all that may apply):
Long-Term TANF(30 Months)/ATAP Recipient
TANF Recipient
Unemployed 15 + weeks
Substance Abuse Issue
Reading Skills below 7th grade
Math skills below 7th grade
Lack of Transportation
High School Dropout/no GED
Single parent
Disabled Individual
Homelessness
Pregnant/Parenting Teen
Lack of Degree
Currently employed/low income
BIA General Assistance Recipient
Last date of employment
Lack significant work history
Limited English Proficiency
Criminal History
Lack of Child Care
Not at age appropriate H.S. grade level
Domestic Violence
No Driver’s License
Foster Care
Child Support Issues
Public Assistance (Food Stamps, GA, etc.)
Employment Information
Employer:
Job Title:
Phone:
Length of Employment:
Employer Address:
Hourly Wages
Monthly/Bi-Weekly/Weekly
Explain in detail: How are you supporting yourself and what has changed in your situation to cause you to
apply for Emergency Assistance? Please include all other information you feel would help us better assist you.
Leaving this area blank will result in an incomplete application and will not be processed.
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__________________________________________________________________________________________
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Under the Privacy Act, 5 U.S.C. 552(a), Section 7(a)(1)(2), the E&T Program cannot give out the information you
give the caseworker with the exception of other Federal, State, Tribal Offices and other programs who have some
responsibility for providing the welfare services for which you are applying. The information can also be given to those
agencies when you ask them for a job or for some other benefit, and for law enforcement purposes. This can be done
without your written consent. For any other person or program wanting information from your case record file, you must
first give your written consent. You have a right to know what information is inaccurate, ask your caseworker about how to
change the information in the case record.
Submit Complete Applications to:
Maniilaq Association Employment & Training
P: (907) 442-7021 Fax: 1-866-832-9350
scholarships@maniilaq.org
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MANIILAQ ASSOCIATION EMPLOYMENT & TRAINING
EMERGENCY ASSISTANCE APPLICATION
Privacy Act Notice (PL 93-579)
The law requires every federal agency maintaining records about people to inform each person, from whom information is
obtained, about the nature and purpose of the record. This includes employment and vocational training records
maintained by the Maniilaq Association Higher Education and Career Development Department, as we have contracts with
the U.S. Department of the Interior, Bureau of Indian Affairs; the U.S. Department of Labor, Division of Indian and Native
American Programs; and the Department of Health and Human Services, Administration for Children and Families.
The purpose of the forms and questions asked of you is to enable us to organize, staff and provide comprehensive
employment and vocational training services to the people we serve. In most instances you may choose not to answer the
questions if you so desire, without risk to your rights and entitlements. However, by giving the information requested of
you, we will be able to carry out our responsibilities to you more effectively, and render better services.
Information provided by you is held in confidence, and is only available to Maniilaq employees who have a need to know in
the performance of their duties. In addition, certain data may be provided to local, state, federal, and other health and
welfare facilities and agencies on a need-to-know basis for continuation of services, to provide for a proper evaluation of
your case file and for reporting as required by the aforementioned federal agencies.
Data may also be made available to approved accreditation agencies and performance standard review organizations for
evaluation of our system; to authorized research personnel with an approved research protocol when no personal
identification data is included, and to the Department of Justice or other law enforcement agencies.
I CERTIFY THAT I UNDERSTAND THE AUTHORITY BY WHICH INFORMATION IS ASKED OF ME, AND THE
PURPOSE AND USE TO WHICH THAT INFORMATION WILL BE PUT, AND THAT PROVIDING ANY INFORMATION
IS VOLUNTARY ON MY PART.
Authorization for Release of Information
I, (applicant) ________________________________________________, and (co-applicant) ___________________________________________________,
hereby authorize the release of information requested by the Tribal Government Services, Employment & Training
Program. The requested information shall be used solely in the administration of Employment & Training and will not be
release to any other person or agency outside the Employment & Training Program or its agents. I hereby authorize the
Employment & Program Services to obtain and exchange information related to my applications to participate in their
programs. And, to arrange for such participations based on my employability assessment and plan to employment related
services and activities. This release of information shall be in effect while I am an applicant or recipient of Employment &
Training benefits.
Persons or organizations that may be contacted include, but are not limited to: the Department of Law, the Department of
Public Safety, the Department of Fish & Game, the Department of Labor, the Department of Military Affairs, Alaska State
Housing Authority, Social Security Administration, local and tribal governments, public assistance program contractors,
stock and grantees, Health Care Providers, Tax Assessors, Financial Institutions, Native Corporations, Stock Brokerage
Firms, Landlords, Employers, School Authorities, private individuals and all departments and programs within and
administered by the Tribal Government Services.
____________________________________________
____________________________________________
Applicant Signature
Applicant Signature
________________________________________________
Printed Name
_________________________________________________
Printed Name
_______________________________
________________
Social Security Number Social Security
Date
Number
_____________________________
__________________
Social
Security
Date Number
Date of
Birth Number Social Security
Date of Birth
Submit Complete Applications to:
Maniilaq Association Employment & Training
P: (907) 442-7021 Fax: 1-866-832-9350
scholarships@maniilaq.org
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