ramp

The Chronic Illness Coalition (C.I.C.) is committed to improving the quality
of life of persons affected by chronic illness, conditions or disabilities.
Applications are accepted annually for candidates who are in need of a
permanent ramp to be installed on their homes front or side door to the
street or driveway.

The grant of $2500 or less (contingent upon available funds) is made
directly to our contractor and will cover the cost of materials and labor.
One person per year is selected. Request for funding must be submitted
and sponsored by a paid C.I.C. Member only on behalf of a candidate
who meets the following criteria:

Candidates must:

submit a written request by a person 18 years old or older

request must be sponsored by an active member

request must demonstrate a poverty level of 150% or less or
extenuating financial circumstances

have an urgent need related to chronic illness, condition or injury,
that has gone unmet despite repeated attempts

be a resident of Michigan

own the property or child of home owner

Requests must include:

wide shot picture of the home

picture of the area the ramp is to be built (front door / side door)

measurement of distance from entryway to street or driveway

number of stairs and thresholds to be covered by ramp

To apply, a C.I.C. Member or member organization must submit a
“Request for Assistance” form on behalf of the client. Requests are
accepted at any time by the C.I.C. Board President. Requests are
evaluated by the C.I.C. Board of Directors monthly meeting and granted
based on the appropriateness of the request and money availability in
the fund.

Chronic Illness Coalition Ramp Program

REQUEST FOR ASSISTANCE

Date: ______________

Member Name:
______________________________________________

Member Organization:
_________________________________________

Member Address:
_____________________________________________

Phone ________________________

E-mail ________________________

Requesting assistance for: Ramp Assistance Fund

Candidate Name:____________________________________________

Candidate Address:__________________________________________

Candidate Phone:_____________________   Age: _____

Please answer the following questions on a separate page:

1.      Describe the urgent need of the candidate and demonstrate
the repeated attempts to meet this need. Highlight any barriers
experienced by the candidate.

2.      Provide the yearly income and any extenuating financial
circumstances.

3.      Detail exactly how the grant will be used to meet the candidate’s
needs and how his or her life will be improved.

4.      Please include a wide shot picture of the home, picture of the area
the ramp is to be built (front door / side door), measurement of
distance from entryway to street or driveway, number of stairs and
thresholds to be covered by ramp.

5.      Any additional information about the candidate.

Mail or fax to:

Chronic Illness Coalition
ATTN: Ramp Assistance Fund Review
21311 Civic Center Dr, 2nd floor
Southfield, MI 48075

or fax to: 248-784-3918

Call with questions, 800-905-8862