General Assistance Application

List of Required Documents

  • Complete GA Application
    Application needs to be signed and dated by applicant and CTC

  • Complete Individual Self Sufficiency Plan (ISP)  

  • Eligibility Review Form

Copies of the Following:

  • Proof of current bills for deductions and Residency
  • Tribal ID or Certification of Indian Blood
  • Photo ID
  • Social Security Cart if SSN is not listed on application
  • Bank Statement for the month that the application was submitted
  • Proof of ALL income for the month the application is submitted
    • Examples
      • Employment Wages
      • Child Support
      • Unemployment Income
      • Self-Employment Income
      • Tax Returns

Cheesh’na Tribal Council

HC01 Box 217

Gakona, AK 99586

907-822-3503

  • Applicant Information

  • Date Format: MM slash DD slash YYYY
  • List ALL MEMBERS of the Household

    Check the box at the left of the name for each person NOT INCLUDED in the General Assistance Application Budget.
  • Check this box only if Person 1 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 2 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 3 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 4 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 5 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 6 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 7 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Check this box only if Person 8 is NOT INCLUDED in your General Assistance budget
  • Date Format: MM slash DD slash YYYY
  • Members of Household with Physical or Mental Handicaps

  • *Emergency is for home burnout, flooding, etc., NOT for eviction/shutoff notices, medical travel, funeral travel, etc. Per 25 CFP Part 20
  • Date Format: MM slash DD slash YYYY
  • Failure to complete this section will render this application incomplete and therefore will not be processed.
  • Record of Income and Resources

    You are required to report income received from the following.
    If yes, list the name of household member(s), source of income, and amounts below.
  • Monthly Shelter Costs

    Provide all expenses for the current month.
  • READ BEFORE SIGNING

    I/We apply for financial assistance/services for the listed members of my (our) household who are in need. I/We have received a copy of and have had explained to us and understand the provisions of Federal Law governing fraud.
  • Date Format: MM slash DD slash YYYY