Application Form

Please note: Failure to complete all information on this form will result in a significant delay in processing your application!

The Intake Process:

• All required fields (*) must be completed before submitting the form.
• After submission, the form will go to a SAWs Customer Service Representative for review.
• If approved, SAWs will contact the client directly if possible. If not, SAWs will contact the Referring Agent.
• If not approved, a Refusal Letter will be sent to the client and copied to the Referring Agent if applicable.

We currently are not taking requests for ramps from the following Indiana counties: Clay, Delaware, Howard, Jackson, Lake and Vigo.