NARI4VETS APPLICATION FORM

The NARI4Vets assistance program is designed to make an impact on and improve the lives of service men and women and their families in the Miami Valley. Miami Valley NARI seeks to coordinate efforts to assist the families of military personnel and veterans by making critical repairs and modifications to their homes. Specific eligibility is required and each project selected to be part of the program will have been reviewed to insure that the modifications made to the veteran’s home will make a significant impact on improving safety and accessibility in their environment. Projects will focus on ramps, door widening and interior accessibility but are not limited to these projects.

Miami Valley NARI will be soliciting applications during the 1st quarter of the year and intends to complete the projects once selected and project planning is completed during the 4th quarter of the year.

Use the form below to apply for assistance:

Your Name:
Contact Phone:
Contact Email:

Applicant / Nominee Information
Name:
Address:
City:	State: Zip:
Phone:
Email:

Which branch of the military did you (or the person you are nominating) serve in?

What timeframe did you or the nominee serve?

Were you or the nominee honorably discharged? Yes No

Did you or the nominee sustain a service related disability or injury? Yes No If yes, please explain:

What remodeling work needs to be done to your or your nominee’s house? Please be as specific as possible:

Do you: Own Rent Other

How many people currently live in the house? Please describe:

Describe how having your home (or your nominee’s) remodeled / improved would help you or your nominee:

What is your or your nominee’s annual household income?

Before clicking submit, please double check that everything has been enter correctly.