Form Center

2. Please complete the following form to indicate your interest in participating in the Older Adults Home Modification Grant Program. Staff will contact you when applications and more details are available.

   Thank you.

   Program Info:

   Provided through HUD’s Older Adults Home Modification Program (OAHMP), the Age in Place grants allow low-income seniors, age 62 or older, to stay in their homes through low-cost home modifications that will reduce their risk of falling. 

   Examples of these home modifications include installation of grab bars, railings, and lever-handled doorknobs and faucets, as well as the installation of adaptive equipment, such as non-slip strips for tub/shower or stairs. 

   The City of Dubuque Housing and Community Development Department will work with medical and social service providers to administer the funds and assist qualified residents in Dubuque. 

4. Property Owner's Name*
5. Preferred Method of Contact:
   -- Select One --E-mailPostal MailPhone
7. Property Owner's Address*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. E-mail Address
18. Do you rent or own your home?*

    1. Rent
    2. Own
    3. Unknown
20. What year was the home built? *

    1. Pre-1990
    2. 1900 - 1920
    3. 1921 - 1940
    4. 1941 - 1960
    5. 1961 - 1980
    6. 1981 - 2000
    7. 2001 - Present
    8. Unknown
22. Do children under the age of 6 live in the home or regularly visit?*

    1. Yes
    2. No
24. Which of the following do you feel applies to your home? Check all that apply.*

    1. Missing grab bars
    2. Thermostat is difficult to read/use
    3. Slippery walking surfaces inside or outside
    4. Broken or uneven steps
    5. Mailbox difficult to reach
    6. Door knobs difficult to use
    7. Bathroom hazards (slipping/tripping)
    8. Flooring hazards (slipping/tripping)
    9. Low lighting in the home
    10. Other
26. Please explain.
28. Do you or someone in your household experience any medical concerns that our inspection staff should be aware of? If so, please explain.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field