Make a Payment
ND Work Orders
SD Work Orders
CONTACT
Follow Us
Make a Payment
ND Work Orders
SD Work Orders
CONTACT

Housing Application

SRHA Housing Application

WELCOME All rental applicants to SRHA, please submit this application in its entirety. You may fill out the form online, or download the PDF and bring it to the SRHA office. You will need to provide Tribal Enrollment documents to verify date of birth.

ONLINE APPLICATION
DOWNLOAD APPLICATION PDF

Wait lists are on a first-come, first-served basis as indicated by date and time stamp. It is the responsibility of each applicant to update their application every 6 months to remain on the waiting list, please remember the date the application was submitted, there will be no reminders mailed.

All composition members 18 years of age and older will be subject to a background check upon selection of a SRHA unit. Please be reminded, if selected and found eligible for a unit, electrical meter must be in Head of Household prior to moving in and remain during tenancy. In most cases tenants are responsible for payment of their electricity and propane.

What makes a potential or current tenant ineligible?

  • Knowingly providing false information on application or to SRHA personnel during recertification

  • Outstanding debt owed to SRHA (except for elderly with a repayment agreement)

  • Conviction of drug-related criminal activity within the past 5 years

  • Conviction of violent criminal activity within the past 3 years

  • Conviction of gang or gang related criminal activity within the past 3 years

  • Currently required to register as a sex offender

  • Evicted from any Housing Authority in the past 5 years

  • Abandoned any Housing Authority in the past 5 years

Upon selection of a unit, this application/questionnaire will proceed with the following:

  • Verification of Income

  • Verification Head of Household has primary custody of children under the age of 18, where applicable

  • Release of Information form completed and signed where applicable

  • Privacy Act Disclosure form completed and signed

  • All verification that is answered “Yes” on this application/questionnaire

Thank you for your interest in renting from SRHA we look forward to serving you, your composition members and working together to keep our homes and communities safe.

Online Housing Application

Housing Application

Household Composition

Please read each question carefully, answer each question completely and be prepared to verify items checked “yes”.

List yourself and anyone who will live with you within the next 12 months. Be sure to include members temporarily away from home, including (but not limited to): dependents away at school, military persons stationed away from home that have a spouse or dependent in the home.

Please list household members starting with Head of Household (HOH) on line 1, then in order of oldest to youngest.

Student Status
Student Status
Student Status
Student Status
Student Status
Student Status
Student Status
Student Status
Student Status
1. Do you anticipate any changes in the size of your household within the next 12 months?
(Examples: a future spouse, a minor entering the home through adoption, children returning from foster care, etc.)
2. Will anyone under age 18 listed above live in the unit less than 50% of the next 12 months?
3. Does any member in your household have a disability and require a live-in care attendant?
4. Is any adult member of your household separated, but not divorced?
5. Does your household receive, or is it applying to receive, Section 8 rental or voucher assistance?

Student Eligibility Questions

6. Are ALL members of your household full-time students?
7. Will ALL members of your household be full-time students during any 5 months of this year?
(Example: a student who goes to school full-time in any parts of January, February, April, October and November)
8. Will ALL members of your household be full-time students during any 5 months of next year?
9. Is ANY ADULT member of your household a part or full-time student in a college or University?
10. Does ANY ADULT member of your household intend to become a student within the next 12 months?

Child Support / Alimony Information

11. Does any member of your household have a COURT ORDER to receive Child Support or Alimony payments, even if no child support is being received?
Include amount and frequency, e.g. $500/month
Are the FULL court-ordered amount(s) being received?
If "NO" are you making efforts to collect amounts due?
12. Does any member of your household receive Child Support or Alimony payments that are NOT COURT ORDERED?
(This includes help from children's father or mother for clothes, groceries, etc.
Include amount (e.g. $500/month), Name of person(s) paying support/alimony, their phone number, and for which child.

Income Information

The questions regarding household income apply to all members of the household, including minors and those temporarily absent from the home.

13. Are any members of the household employed? (Do not include self-employed.)
Include amount and frequency, e.g. $2,000/month
Include amount and frequency, e.g. $2,000/month
(You may be contacted for additional employment information.)
14. Are any members of the household self-employed?
Include amount and frequency, e.g. $2,000/month
15. Are any adult members of your household unemployed?
16. Does any household member receive pay from the military?
Include amount and frequency, e.g. $2,000/month
17. Does any household member receive any payments from Social Security Administration?
If yes, which type?
Include amount and frequency, e.g. $2,000/month
18. Does any household member receive severance pay or worker's compensation?
Include amount and frequency, e.g. $2,000/month
19. Is any household member unemployed and receiving payments from an Unemployment Agency?
Include amount and frequency, e.g. $2,000/month
20. Does any household member receive Public Assistance payments such as TANF or AFDC?
(Please do not include Food Stamp benefits here)
Include amount and frequency, e.g. $2,000/month
21. Does any household member receive periodic payments from pension, annuity, or a retirement benefit account?
If yes, check one
Include amount and frequency, e.g. $2,000/month
22. Does anyone outside of your household provide you with cash or contributions to help pay expenses that a household would normally pay, such as rent, utility payments or groceries?
Include amount and frequency, e.g. $2,000/month
23. Is there any other source of income we haven't already asked about above that you receive?
24. Does your household expect any changes in their income within the next 12 months?
25. Does your household receive long-term care insurance payments, more than $180 per day, for a family member residing in a long-term care facility?
Include amount and frequency, e.g. $2,000/month
26. Do any adult members of your household have zero income?

Account / Asset Information

The questions regarding household accounts/assets apply to all members of the household, including minors and those temporarily absent from the home.

27. Does any household member have a checking, savings, CD, or Money Market account?
Account Types
(Check all that apply)
Account Types
(You may be contacted for additional account information.)
28. Does any household member have stocks, bonds, mutual funds, capital investments or a whole life insurance policy? (Life insurance that you can make withdrawals from even if there isn't a death. We do not count TERM life insurance.)
29. Does any household member have an IRA, Keogh, 401(k), annuity or similar retirement?
Account Type
30. Does any household member have a pension account that will pay upon retirement or termination of employment (NOT including IRA, Keogh, 401(k) or annuity accounts)?
31. does any household member own any Real Estate? (Include rental property, primary residence, vacation property, time-shares, commercial property and property being sold by deed of trust or contracts for deed.)
32. Does any household member have personal property that they hold for investment purposes that they plan to sell later for profit? (Examples include coin or stamp collections, antique cars, jewelry, etc.)
33. Does any household member have a Trust Account?
Is this a Revocable or Non-Revocable Trust Account?
34. Does any household member have any Treasury Bills or Government Savings Bonds?
35. Does any household member have cash on hand or safe deposit boxes?
36. Does any household member have any accounts or assets that were not described above? (Please DO NOT include personal use of vehicles, furniture, clothing, etc.)
37. In the past two years, have any household members given away an asset(s) for less than they were worth? (Examples include property, transferring an asset account into someone else's name, charitable contributions, etc.)

Household Certification

By providing your full name below, you agree that your electronic signature holds the same legal validity and enforceability as a handwritten signature.

I understand that the information provided on this questionnaire will be used to determine my eligibility for compliant properties. Under penalty of perjury, I certify that the information I provided is true and accurate to the best of my knowledge. I also understand that providing false information is considered fraud and punishable according to the law and may result in loss of my housing at this property.

I also understand that the information provided is confidential and will be used solely for the purpose of determining my eligibility or continued eligibility in this housing program.

CERTIFICATION: All household members who are 18 years of age or will be 18 years of age within the upcoming 12-month period must type their full legal name below to sign.

Note: Standing Rock Enrolled Members receive priority, Standing Rock Enrolled Members who are Veterans also receive priority. We do not discriminate based on Familial Status, Race, Sex, Disability, Color, Religion, or National Origin.