Housing and Homelessness Program
Information for Grant Recipients

Reimbursement Requests

The Homeless Housing Grant Program and the Affordable Housing Grant Program share a single reimbursement request form:

*This link takes you to our electronic submission system, powered by DocuSign.  This form includes a Reimbursement Request Form and a Summary Statement of Expenses.

Important Note: Before you click the link, you must have all the information you will need to submit the reimbursement request assembled.  Unfortunately, you cannot save your work once you've started.

You can look at a example blank Reimbursement Request Form and Summary Statement of Expenses Form.


Example Forms:

Example Reimbursement Form

Example Summary Statement Form


Official Forms:


Electronic Reimbursement Request Form

*For Reimbursement Request Summaryof Expense that include more than 14 seperate line items, please use the following form;

Electronic Reimbursement Request (Extended) Form

We have designed the system with your ease and efficiency in mind; please don't hesitate to call with any questions.  Staff will be happy to walk you through the process if you need assistance.

​Contact Us

   Kirsten Jewell, Program Coordinator
   360-337-7286 or kjewell@co.kitsap.wa.us

   Corey Derenburger, Program Specialist
   360-337-7287 or cderenbu@co.kitsap.wa.us

   Doug Washburn, 
   Director Department of Human Services

​Quarterly Reports; Affordable Housing Grant Program

AHGP -Q-Reports
AHGP-Final Progress


To Submit:
AHGP-Final Progress

​Quarterly Reports; Homeless Housing Grant Program

HHGP-Final Progress


To Submit:
HHGP-Final Progress