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Delaware Nation Housing (Delaware Nation)

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Delaware Nation Housing
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Revised 10/2018 Page 1 of 6
Tribal Rental Assistance Program Guidelines
The purpose of the Delaware Nation Tribal Rental Assistance Program is to provide assistance to low-income
Native American families trying to obtain suitable rental housing in the private sector. The Rental Assistance
Program will provide a forgivable loan up to $1,000.00 to eligible low-income enrolled tribal members to defray
the cost of move-in expenses. In order to be eligible, applicants must:
A. Have completed application
B. Reside or propose to reside within area of operations; if participant is a Delaware tribal member this
program is covered state wide
C. Be classified as a low-income Native American family according to the United States Median
Income Guidelines, see chart below. (preference will be given to enrolled Delaware tribal members,
but this program will operate as a “first come, first served” program)
2019 United States Median Family Income Limits at 80% Published June 21, 2019
FAMILY SIZE
1
2
3
4
5
6
7
8
MAX
INCOME
$42,280
$48,320
$54,360
$60,400
$65,232
$70,064
$74,896
$79,728
D. Be willing to sign a promissory note for the amount of the loan
E. Must have a minimum annual income of $15,600 (minimum wages)
F. Applicant must not already reside within the proposed unit for which they are applying for
assistance.
The Delaware Nation Housing will not write checks directly to the participant, but rather to the vendors
to which the expense will be paid. You must provide the name, address, and contact information for all
vendors that you wish to utilize.
Eligible Activities for this program shall include:
A. First month residential rental payment
B. Additional up-front residential rental payment required by property owner
C. Security Deposit for residential rental property
D. Utility deposits for initial utility services (includes electricity, water, sewage, and/or garbage)
E. Natural Gas deposits for initial services
Ineligible Activities for this program shall include:
A. Residential rental payments that are not required for move-in (on-going monthly payments)
B. Past due residential rental payments (even if required for move in)
C. Past due utility or natural gas payments (even if required for service)
D. Telephone deposits
E. Cable television deposits
Delaware Nation Housing
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Revised 10/2018 Page 2 of 6
Application Checklist:
Applicants must complete a Residential Rental Assistance application. The application packet and
other submissions consist of the following:
1. Application.
2. Tribal enrollment documentation for members in the household. If enrolled with Delaware
Nation and you do not have your card available, Housing staff can verify enrollment with
the Enrollment department.
3. Copy of Birth Certificate for primary applicant. If not available at the time, Housing may
accept valid state identification card.
4. Copy of Social Security Card for primary applicant.
5. Income verification from all sources of income for members living in home.
6. Landlord Good Faith estimate: To be completed and signed by landlord.
7. Move-in expense sheet: Including addresses and phone numbers for all vendors listed. If
requesting assistance with utility/gas deposit you must acquire an account number
and provide documentation from the company before Housing can have payment
applied to account.
Delaware Nation Housing
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Revised 10/2018 Page 3 of 6
Application for Residential Rental Assistance
Date: _____________________ Name of Applicant:_____________________________________________________
Contact Address: _________________________________________________________________________
City: ________________________________ State: ________________________ Zip Code: _________
Contact Phone (______) _________________ Alternate Contact Phone (____) _______________
For the main Applicant, please submit copies of your Birth Certificate, Social Security Card and Tribal
Enrollment Documentation
List individuals who will reside in the rental property:
Name
Relation to client
Date of Birth
Social Security
Enrolled Tribe
*For all persons listed above, please attach copies of tribal enrollment documents
List Monthly Income of all household members:
Name
Monthly Income amount
Source
List Net Family Asset: (example: checking/ savings accounts; lease/royalties; stocks; bonds; etc.)
Type of Asset
Estimated Value
Delaware Nation Housing
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Revised 10/2018 Page 4 of 6
Proposed Address: (physical Address and mailing address of the rental property you are pursuing)
Mailing Address: ______________________ Physical Address _________________________________
City: ____________________ State: ________________ Zip Code: _____________________
Name and Address of Proposed Landlord
Name: _________________________________________________ Owner or Manager
Address: ________________________________________________
City: __________________ State: _____________ Zip Code: _____________
Contact Phone: ______________________
Have you or any person listed as a family member received housing assistance from the Delaware Nation
Housing Program before? If yes, when? ______________________________________
Certification:
I understand that this is not a contract and does not bind either party. I certify that the information
given in this application is true and correct to the best of my knowledge. I understand that willful, false
statements or mis-representations are criminal offenses and could cause me to be ineligible for the
housing assistance. I have no objections to inquiries being made for the purpose of verifying the
information given herein.
____________________________________ ______________________________________
Signature of Applicant Date Signature of spouse Date
____________________________________ _______________________________________
Signature of Adult Member Date Signature of Adult Member Date
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Delaware Nation Housing
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Revised 10/2018 Page 5 of 6
Move-In Expense Budget
Expenses Vendor Name & Address Amount Approved
(SHADED AREA FOR OFFICE USE ONLY)
First Months’ Rent $________
Additional Rent
Required $________
Security Deposit $________
First Months’ Rent $________
Additional Rent
Required $________
Security Deposit $________
Utility Deposit $________
Additional Fees $________
Utility Deposit $________
Additional Fees $_________
Utility Deposit $________
Additional Fees $________
Utility Deposit $________
Additional Fees $________
PARTICIPANT
RESPONSIBILITY $__________
Documentation Attached _______
Verbal Verification ___________
___________________________
DELAWARE NATION
NOT TO EXCEED $ 1000.00_
Total Move-In
Expenses $_________
Denied By:__________________
Total Amount
Approved $___________
Notes: ___________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Delaware Nation Housing
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Revised 10/2018 Page 6 of 6
Rental Property Good Faith Estimate
(To be completed by landlord)
The following rental property is owned/managed by:
________________
(PRINT) First Last
Address of Property
City State
This rental unit will be available for move in on . Negotiations of
rental amount and security deposits have taken place and I can estimate in good faith that the move-
in expenses will be as follows:
Rental amount required to take possession:
Regular Monthly Rental Amount:
Security Deposit:
Contingencies: (Please list any contingency factors that could cause the unit to become unavailable
or any other factor that may alter the information listed above.)
Applicant Signature: Date:
Landlord Signature: Date:
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Completed 20 July 2020

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