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<br /> Harry Kim Duane Hosaka <br />MayorHousing Administrator <br /> <br /> <br />Alisa A Hanselman <br />Assistant Housing <br /> <br />Administrator <br />Office of Housing and Community Development <br />2 <br />V/TT (808) 959--9308 <br />KONA: 74-- <br />(808) 323--4301 <br />RESIDENTIAL REPAIR PROGRAM APPLICATION (RRP) <br /> <br /> <br />PART 1: GENERAL INFORMATION: <br /> <br />APPLICANT <br />(Head of Household): _________________________________________ Phone:________________________ <br /> Legal Last Name First Name MI <br /> <br />CO-APPLICANT <br />(Spouse or Co-Head): _________________________________________ Other Phone:___________________ <br /> Legal Last Name First Name MI <br /> <br />Current Address: ____________________________________________________ Apt. No._______________ <br /> <br />City: ___________________ State:________________________ Zip:___________ Yrs. at Residence:___________ <br /> <br />Previous address if less than 2 yrs. at above ________________________________________ Yrs. at Residence:___________ <br /> Check here if mailing address is the same as current address. <br /> <br />Mailing Address: ____________________________________________________ Apt. No.__________ <br /> <br />City: _________________________________ State:________________________ Zip:______________ <br /> <br /> <br />PART 2: HOUSEHOLD MEMBERS: <br />Starting on first line for the Head of Household, please supply the information for all adults and children that will live in the housing unit to be assisted. <br />List the f each adult and child <br />listed. H = Head of Household K = Co-Head (Not Married) Y = Youth Under 18 L = Live In Aide <br /> S = Spouse (Married) F = Foster Child/ Adult E = Full Time Student Over 18 A = Other Adult <br /> <br />Last Name & Sr, Jr, etc. First Name MI Date of Birth Sex Relation <br />1 <br /> <br />Single Race (select one or more) Ethnicity (check one box) <br />\[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino <br />\[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino <br />\[ \] American Indian / Alaska Native <br />Multi Race (select one or more) <br />\[ \] Asian and White \[ \] Other Multi-Racial <br />\[ \] Black or African American and White <br />\[ \] American Indian / Alaska Native and White <br />\[ \] American Indian / Alaska Native and Black <br /> <br /> EQUAL HOUSING OPPORTUNITY <br />AI`I COUNTY IS AN EQUAL OPPORTUNITY <br /> <br /> <br />