Preliminary R.I.S.E Specially Adapted Smart Home Application

Is the applicant a first responder or military personnel?

First responderMilitary personnel

Were you injured in the line of duty?

YesNo

Where did the injury occur?

Military Status

First Responder Status

Date of Retirement

Has the applicant been determined by the VA to be entitled to the Specially Adapted Housing (SAH) grant?

YesNo

First Name

Last Name

Phone

Address Line 1

Address Line 2

State

City

Zip Code

Branch of Service

Rank

Date of Injury

Brief description of injuries & how they occurred? (1,500 characters)

Desired location of Specially Adapted Home (City, State)

How did you hear about the Gary Sinise Foundation?

Based on the preliminary data provided, the applicant is not eligible for our R.I.S.E. Specially Adapted Home Program.

The applicant may qualify for other forms of assistance.

If you have any questions regarding the qualification process, please submit an inquiry through our website.