All required fields with * must be completed. After submission, the form will go to a SAWs Customer Service Representative for review.
If approved, SAWs will contact the client directly.
If not approved, a refusal letter will be sent to the client.
We are currently are not taking requests for ramps from the following counties:
Clay, Delaware, Elkhart, Howard, Lake and Vigo.
SAWs also does not serve the following counties due to an existing group in that area:
Allen, Adam, Clark and Floyd
Complete this section if the Referring Partner Agency address has changed.
To be completed by Interview team
By Submitting this Agency Partner Ramp Referral Form, I am certifying on behalf of the submitting agency that
1) the person for whom the ramp request is submitted has a recognized disability necessitating a ramp for access, and
2) the [person/household] has an annual income of not more than 60% of area median income (AMI) in the county in which the residence at which the ramp is to be constructed is located.
If project is closed a Refusal Letter must be sent.
The workflow process will skip to Refusal Letter Required, Step #10.
Waiver of Liability is for the client.
Permission is for landlord if a rental.
Upload and the file copy of the signed waiver. If waiver is not received the project will be closed.
You may go back 1 step to Send Waiver and Permission if waiver needs to be resent.
Property is owned.
No Permission needed. Submit Form.
Please indicate whether the Permission from landlord was received, upload and file.
Please enter the date that the site evaluation was completed, and attach file(s).
Please enter the date of drawing(s) completion and attach file(s).
Section will not allow data entry if closed during Validation, Waiver Received or Site Evaluation Steps.
Please enter the scheduled date of prefabrication.
Please enter the scheduled date/time of Installation.
This Project Was Closed in a Previous Step.
Enter date refusal letter was sent and upload form.
Submission will be completed when form submitted.
Please enter date project Finished and/or Completed.
No client confidential information.