Apply for Services
Solicitar Servicios
If you are in need of fall prevention home modification services (grab bars, bathroom assistance devices, a wheelchair ramp, etc.) please click the online application button below. Proof of income can be uploaded to the online application.
Proof of Income Documentation for Each Household Member:
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Bank statements from the previous three months
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Income Tax Return from the previous year (If filed)
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Social security or disability award/determination letter, OR three most recent payroll check stubs
(Don't forget to block out social security and bank account numbers)
En Espanol:
Si necesita servicios de modificación del hogar para la prevención de caídas (barras de apoyo, dispositivos de asistencia en el baño, una rampa para la silla de ruedas, etc.), haga clic a continuación para descargar una solicitud.
Para la aplicación en español, haga clic aquí.
To Submit Documents by Mail or Email:
1826 W. Broadway Rd., Ste. 16
Mesa, AZ 85202