The Downsizing Daughters Safe Home Grant Application
The Downsizing Daughters Safe Home Grant is a community initiative providing small grants (typically $250–$1,000) to help seniors who own their homes make safety upgrades like grab bars, ramps, lighting improvements and small devices.
Applicant Information
Name
*
First Name
Last Name
Please enter your Date of Birth.
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Please enter your phone number.
*
Please enter your home address.
2. Do you own this home?
Yes
No
3. How long have you lived in your home?
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Household & Support
4. Do you currently live alone?
Yes
No
5. If you answered "no" to the previous question, who lives with you?
6. Do you have family and/or caregiver support nearby to assist you?
Yes
No
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Your Home Setup
7. What type of home do you live in? If other, please specify.
Detached
Semi-detached
Townhouse
Bungalow
Condo
Other
8. How many floors does your home have including the basement?
9. Do you have stairs inside your home?
Yes
No
10. Do you have stairs at the entrance of your home?
Yes
No
11. Do you use any mobility devices?
Yes
No
12. If you answered "yes" to the previous question, please specify. (e.g. walker, cane, scooter etc.)
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Current Safety Concerns
12. Have you had any recent falls or near-falls in the home?
Yes
No
13. If you answered "yes" to the previous question, please let us know what occurred, and when.
14. Which area(s) of your home feel unsafe or difficult to use? If other, please specify.
Bathrooms
Stairs
Kitchen
Entrance/porch
Hallways
Bedroom
Other
15. Are there are tasks that you avoid because you feel unsafe?
Yes
No
16. If you answered "yes" to the previous question, please list the task(s) below.
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Requested Modifications
17. Are you applying for the grant to help pay for safety updates that have already been completed, or for upgrades that still need to be completed?
Updates that have already been completed
Updates that still need to be completed
A bit of both of the above
18. What safety improvements are you hoping to receive help with? If other, please specify.
Grab bars
Shower/tub modifications
Stair rails
Kitchen safety (anti-slip mats, lighting)
Entryway improvements
Small technology device
Other
19. Why do you feel these changes are needed right now?
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Financial Information
20. Are you currently on a fixed income?
Yes
No
21. Do you receive any of the following? (check all that apply)
CPP
OAS
GIS
Disability
Pension
None
22. Monthly household income range. (Optional but helpful)
Under $2,000
$2,000–$3,500
$3,500–$5,000
Over $5,000
Prefer not to say
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Permission, Access & Media Release
23. Are you comfortable having a licensed contractor enter your home to install the safety features?
Yes
No
24. Are there any pets, access considerations, or special instructions we should know before visiting?
25. As part of accepting the Safe Home Grant, do you agree to allow the Downsizing Daughters Group to take photos and short video clips of you and the completed safety upgrades? (These help us show donors and future applicants the impact of the grant.)
Yes
No
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Agreement Section
I confirm that I am the homeowner applying for the Safe Home Grant. I understand that this grant is for safety-related modifications only. I agree to allow the Downsizing Daughters Group or approved contractors to contact me about this application.
Please enter today's date.
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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