ADRC Vehicle Modification Program Application

Don’t miss your chance for greater mobility at absolutely no cost. With a hassle-free process and limited funding available, now is the time to act!

Here’s how it works:

Fill Out this Simple Form: Get started in minutes.
We Handle the Details: Our team contacts you, finds the right lift, and submits the estimate (up to $7,000) to ADRC for approval.
Hassle-Free Installation: Once approved, we schedule and install your lift.
No Cost to You: ADRC covers the cost – you pay nothing.

Eligibility:

Waukesha County residents, 18 or older.
Individuals with disabilities that impact their ability to access or use a personal vehicle without modifications.

Name:

Email:

Phone:

Birthdate

Age

Gender

Permanent Address

Are you between the ages of 18-59 and identify as having a disability?

Do you receive VA disability benefits?

Do you use any of the following:

Electric Wheelchair

Scooter

Do you own the vehicle you are looking to modify?

If no, please explain

Name and phone number of vendor performing the modification:

Free Text

The information provided in this application is true and correct. I understand that deliberately providing false information is punishable by law and may jeopardize the receipt of services. I hereby authorize the Aging and Disability Resource Center to verify the information in this application.

Signature of Applicant (type name)

Date