Ramp Up RI - Application

Ramp Up RI Application
Dear Applicant: Please complete this application as accurately as possible to help us determine your eligibility for the South County Habitat for Humanity (SCHH) Ramp Up RI program.

Please note - we can only provide services to homes located within Washington County, Rhode Island.

If you have any questions regarding this application, please contact the SCHH office at 401.213.6711 ext. 305.

Is the home in need of a ramp located in Washington County? (SCHH can only provide services to those located in Washington County, RI).*

Yes - the home is in Washington County
Applicant Information
Applicant Name*

First NameLast Name
Are you the applicant?*

Yes - I am the applicantNo - I am completing this form on the applicants behalf
Applicant Date of Birth*

YearMonthDay
Date
Phone number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the home rented or owned?*

The applicant owns this homeThe applicant rents this home
Landlord name and contact information
Landlord name and contact information
Are any household members active duty military or Veterans?

YESNO

Household Income*

	Household member name	Age (only include those 18+)	Total gross monthly income	Source of income (if applicable)
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6

Ability to Repay

SCHH is committed to providing a hand up, not a handout. As such, you will be responsible for repaying the cost of the ramp installation through a 0% interest loan from SCHH. We will waive the first $500 of the total ramp cost as a grant. Any amount beyond $500 will be payable to SCHH over a period of one to three years. We will work with you to establish a monthly payment plan that fits your budget.
Do you agree to repayment of a 0% loan for ramp costs in excess of $500?

I AGREEI DO NOT AGREE

Applicant Agreement

I understand that by submitting this application, I am authorizing South County Habitat for Humanity to evaluate my need for a ramp and my ability to repay a no-interest loan.
Do you agree to the above Applicant Agreement?

I AGREEI DO NOT AGREE

Required Documents

This section lists documents required to submit as part of your application. Documents may be uploaded here or mailed to us at: South County Habitat, PO Box 68, Shannock, RI 02875.
Upload current driver's license or equivalent

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Upload proof of current homeowner's insurance

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Upload proof of income for all household members 18 and older. (As applicable please provide current award letters or 2 months of pay stubs).

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How did you hear about South County Habitat for Humanity?

Electronic Signature

I understand that by submitting this application, I am authorizing South County Habitat for Humanity to evaluate my need for a ramp and my ability to repay a no-interest loan. Please sign electronically in the space below.
Signature (use a finger, mouse, stylus, etc. to sign below)

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Ramp Up RI Application