Aging in Place Pre-Application
The East Central Intergovernmental Association has been awarded $1,000,000 in Older Adults Home Modification grant program funding. We will be completing safety and functional home modifications and limited repairs in 100 units* to meet the needs of low-income elderly homeowners. 

Please tell us about yourself below and we'd be happy to reach out! If you have any questions, please contact us at 563-556-4166 or seniorhelp@ecia.org.
Sign in to Google to save your progress. Learn more
First and Last Name
Address *
City *
County *
Zip Code *
Phone Number
Email Address
Age
When is the best time to contact you?
Additional Comments
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy