Care Thru Cars | Digital Application

Nominating Party (If you are applying for yourself, please scroll down to the Recipient Info Section)

Email (Nominating Party)

Phone Number (Nominating Party)

Address (Nominating Party)

City

State

Zip Code

Relationship to Recipient

Recipient Info

Recipient Email

Recipient Phone #

Recipient Address

City

State

Zip Code

Is the recipient a U.S. Citizen?

Yes

No

Is the recipient currently eligible to work in the United States of America?

Yes

No

Will the recipient require visa sponsorship to continue working in the United States?

Yes

No

Is the recipient currently employed?

Yes

No

How would a vehicle change the recipient's life? Why does the recipient need a vehicle?

What else should we know about the recipient?

Does the recipient have any medical limitations with regards to driving a vehicle?

Vehicle Accommodations

How did you hear about Care Thru Cars?

CARE THRU CARS APPLICATION