Ramp Program Pre-Application

Ramp Program Pre-Application

Our Ramp Program helps homeowners with limited mobility by providing custom-built exterior wheelchair ramps. Completing this form will add you to the waiting list for the 2026 Ramp Season.
Name of homeowner requesting a ramp*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
65 years old or aboveBelow 65 years old
I understand
Yes, the applicant owns the home that requires a rampI am inquiring on behalf of the homeowner who requires a ramp
If you are inquiring on behalf of the homeowner, please tell us your name

First NameLast Name
Phone Number of person inquiring on behalf of the homeowner
Please enter a valid phone number.Format: (000) 000-0000.
Briefly describe the ramp request (which doorway, how many steps, etc.)
Once we receive this pre-application, our staff will reach out to you and schedule a time to visit your property and evaluate your request. If you have any questions, you may call the Chemung County Habitat for Humanity office at (607) 734-1361 for more information.
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