Handicap Ramp Application Form

BRIDGE BUILDERS

Nazarene Men's Group

Handicap Ramp Application Form

Date:

Applicant's Name:

Residence Street Address:

City: Zip:

Contact E-mail:

Telephone Number: Cell Phone Number:

Owner Of Property:

Reason For Request:

Recommendation from physician or medical professional:

The purpose of the Bridge Builders Group is to build handicap ramps for people who are in need of a ramp to enter or exit their home. Labor is free; however, it is helpful if all or a portion of the cost of the material comes from the applicant. If project is approved, but there are not funds provided by applicant, we will attempt to make provisions to cover the cost.

Amount Contributed By Applicant:

(Please note: If at some point in time this ramp is no longer needed and materials are still useable, please notify us and will come and take it down at no cost.)

Just fill out form and submit

Or you can fill it in then print and turn in to the church office

If you have questions e-mail Mr. David Ferguson at: