Ramp up Success Application

Is your organization requesting an ADA compliant aluminum access ramp or bathroom retrofit to ADA compliance (one stall) Yes No

How many MHS Hoosier Care Connect Members does your organization serve each month * 100+ 50 to 99 0 to 49

Does your organization offer emergency housing? * Yes No

Does your organization have a food pantry onsite? * Yes No

Has your organization partnered with MHS on any outreach events in the past 24 months? * Yes No

Does your organization serve the Aged, Blind or Disabled population? * Yes No

Is your organization contracted with MHS as medical or behavioral health provider? * Yes No

Is your organization a Minority/Women-owned Business Enterprise (MWBE)? * Yes No