Habitat for Humanity Capital Region - Ramp Application
Thank you for your interest in the Accessibility/Ramp Program at Habitat Capital Region! Please keep in mind that this application does not guarantee services but is the first step in the process to receive services.
Email address *
Today's Date *
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Are you completing this application for yourself or someone else? *
If completing this application for someone else, please provide your name, contact information, and relationship to the individual in need of a ramp.
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Who is the preferred contact to discuss the ramp request?
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Name of individual in need of a ramp *
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Address where ramp will be installed *
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City, State and Zip Code *
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Phone number *
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Email address
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Please provide the name and birth date of each member of the household. *
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Please list all household members that are currently in school.
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Do you own or rent the home? *
If you rent or live in a mobile home park, please provide landlord or community name and contact information.
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If you own your home, do you have current homeowner's insurance?
If you own your home, please list your homeowner insurance provider and their contact information?
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Is this a mobile home? *
Does any resident of the home appear on the Michigan Public Sex Offender Registry or the National Sex Offender Registry? *
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