Apply To The Program - Tucker's House

Submit an Inquiry Form to Get Started

If you are in need of the services Tucker’s House provides to make your home safe and more accessible, please fill out our inquiry form below.

We are currently accepting applications that will be reviewed in the April 2023 application review period. The first step in the process is completing the inquiry form below. After completing the form, a Tucker’s House representative will be back in touch with you about the next steps in the process.

Your Name(Required)

First Last

Client's Name

First Last

Relationship to Client

Email(Required)

Phone(Required)

Location of Requested Service(Required)

City State ZIP Code

Home in Which Client Lives is(Required)

Owned

Leased

How did you hear about Tucker's House(Required)

Online

Physician or Therapist

Agency

Relative or Friend

Brochure/Flyer

Other

Questions/Comments

A Tucker's House representative will reach out to you shortly. Thank you for contacting us.

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