6090 Boxer St, Utqiagvik, AK 99723
(907) 852-4411
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NEWS & UPDATES
Contact Us
HOME
Who We Are
ABOUT
Administration
Tribal Courts
Tribal Council
Tribal Operations
WHAT WE DO
ARPA Department
EPA
Housing/NASHASDA
NALEMP Department
Workforce Development & Childcare Services
Realty
Social Services
Tribal Courts
Tribal Council
Tribal Transportation
Wildlife Program
RESOURCES
Careers
FAQ
NEWS & UPDATES
Contact Us
ARPA
SLFRF Survery
Quyanaqpak for assisting us with this survey!
Member Information
Member Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Would you like to receive NVB newsletter?
(Required)
Yes
No
How would you like to receive the NVB newsletter?
(Required)
Email
Mail
Address Information
Current Mailing Address
(Required)
Street Address
City
Alabama
Alaska
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Delaware
District of Columbia
Florida
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Ohio
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Rhode Island
South Carolina
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Street (Physical) Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Information
Do you currently rent or own your primary home?
(Required)
Rent
Own
If you own, what type of financing do you have?
(Required)
184 Loan
Modular Loan
Tribal or Reginal Housing Authority Loan
Mortgage Loan from Bank or Credit union
VA Loan
Alaska Housing Finance Corporation Loan
Other
Other:
(Required)
Please list the type of financing you have if not listed above.
What is your average heating cost?
(Required)
Is your heating costs different in winter?
(Required)
Yes
No
What is your primary heating source?
(Required)
Heating oil
Electric
Natural Gas
Other
Other:
(Required)
Please list the type of heating source you have if not listed.
Please identify your homes water and sewer type
(Required)
Piped (city connection)
Pump and haul
Honey bucket /water delivery
Other
Other:
(Required)
Please list the type of heating source you have if not listed.
What is your average water and sewer cost per month?
(Required)
Household Information
Based on age, please provide the number of people that live within your household in the appropriate box.
Age (0 to 2)
(Required)
Age (3 to under 18)
(Required)
Age (18 to 35)
(Required)
Age (40 to 62)
(Required)
Age 62+
(Required)
Are you a military retiree or a veteran?
(Required)
Yes
No
Branch of Service
(Required)
Please identify all that apply to your household.
(Required)
Single Parent
Person with Disabilities
Multiple families under one home
Veterans or military members
Living with parents or grandparents due to house shortage
Other
Other, please explain:
(Required)
Please identify all that apply to your household if not listed.
Income/Employment
What is your estimated annual income?
(Required)
What is your current employment status or your form of income?
(Required)
Full-time
Part-time
Temporary
Seasonal
Retired
Disability
Student
Other
Other
(Required)
list your other form of income if not listed above.
ARPA Program
Have you ever used ARPA before?
(Required)
Yes
No
If yes, what program:
(Required)
Check the boxes of which programs may best benefit your home and household needs in the future.
(Required)
Student assistance
Family last will assistance
Sewer/Water
Substance abuse
Homelessness
Advanced education assistant
Broadband
Emergency travel
Supplies for children
Food supplies
Mental health services assistance
Other
Choose all that apply
Other
(Required)
list any program not listed above
If there was a specific item, you would hope the ARPA funds can help with what would that be:
(Required)
Yes
No
If yes, please let us know what:
(Required)
