Must be Completed and Signed by ALL Members of the Household that are 18 and older or an Emancipated Minor.

BACKGROUND CHECKS WILL BE COMPLETED ON ALL ADULTS IN THE HOUSEHOLD.

I/We have applied for a program or are currently residing in a unit under the management of the Salish & Kootenai Housing Authority (hereinafter SKHA.) As part of the application/certification process SKHA may need to verify information contained in my/our application or file update and in other documents that are required.

I/We authorize you to provide SKHA all information and documentation that they request.

This authorization also includes any minor children of the above named individuals.

All household members age 18 or older or Emancipated Minor please fill in your full legal name and list your Social Security Number below:

Your prompt reply to SKHA is appreciated. Furthermore I/We grant SKHA permission to release information necessary in assisting me/us in obtaining other services for which I/We may be eligible.
All household members age 18 or older or Emancipated Minor sign below: