Uplift Project Eligibility Questionnaire
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Age
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Which of the following most closely describes you? (please select all that apply)
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Required
First and Last Name *
Address/City/State/ Zip *
Email Address *
Phone Number  *
Do you live in Hamilton County? *
Are you 21 or older? *
Can you provide a valid driver's license? If applying on behalf of someone else, can you provide a valid license for the owner of the vehicle? *
Can you provide a current and valid vehicle registration? (Must be owned and registered in the client's name for at least three months.)  *
Do you have auto liability insurance? *
Are you employed at least 25 hours a week OR attending a technical school or college? *
Is your vehicle inoperable?
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Can you provide proof of income that is consistent with 200% of federal poverty guidelines? 
See table below for household size and income**
(Ex: Household of 1= $29,160     5= $70,280
                                 2= $39,440     6= $80,560
                                 3= $49,720     7= $90,840
                                 4= $60,000     8= $101,120

**NOTE: Special exceptions may be considered on a case by case basis.  
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Can you provide proof of enrollment in technical school or college? *
Has there been a DUI, DWI, or vehicular felony on your license within the last five years? *
Where did you hear about The Uplift Project? *
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