Maurer-Heinsen Home Access Program

The Maurer-Heinsen Home Access Program is a compassionate and practical initiative dedicated to enhancing the lives of individuals living with Amyotrophic Lateral Sclerosis (ALS). The program recognizes the importance of accessibility for those with mobility challenges and covers a significant portion of the cost associated with the installation of temporary modular ramps to ensure that people living with ALS can easily navigate in and out of their homes.

To qualify for this program a person must have a diagnosis of ALS/PLS/PMA and no other resources that will cover needed items (e.g. County Assistance, VA, long-term care policy).

If you participate in a county assistance program, please contact your county case manager for information on home modifications.

If you are a veteran, please contact your benefits administrator for information on home modifications.

If you have a Long Term Care Policy, please check to see if it helps to cover the cost of a ramp and let us know when we reach out to you.

PLEASE NOTE: This program is for anyone living with ALS/PLS/PMA and registered with The ALS Association and living in Iowa, Minnesota, North Dakota, South Dakota, or Wisconsin.

For more information about requirements/restrictions - click HERE

Eligibility
Please answer the following questions to confirm your eligibility for this program.

Who is filling out this form

I am a person with ALSI am assisting a person with ALS or submitting on their behalf

Is the person with ALS registered with The ALS Association in one of the following states?

Does the person with ALS own their home?

Yes

No

Is the home part of a Home Owners Association?

Yes

No

Is the person with ALS enrolled in a County Assistance Program that helps with home modifications?

Yes

No

I have reviewed my answers above and all information is correct.

YesNo

Person with ALS

PERSON LIVING WITH ALS INFORMATION

First Name

Last Name

Email

Phone Number

What is your preferred method of communicating with us?

Email

Phone

Date of Birth

Date of ALS Diagnosis

Address Line 1

Address Line 2

City

Zip/Postal Code

State

County where the ramp is needed

ALS Physician

ALS Clinic

I have reviewed my answers above and all information is correct.

YesNo

Your Info.

Your Information

Please share your contact information with us in the event that we have any questions.

First Name

Last Name

Email Address

Phone Number

What is your relationship to the person living with ALS?

I have reviewed my answers above and all information is correct.

YesNo

Acknowledgement

By typing my name and dating below I hereby authorize The ALS Association to release the above information to Next Day Access, a designated ALS Association partner, to provide ramp services for the Ramp Program.

I understand that fees are negotiated on my behalf and I will be able to accept or decline these fees.

I also understand that this is a cost-share program, meaning there will be some out-of-pocket expenses on my part and that my purchased items will be returned to the program when no longer in use.

Type your name as your signature

Today's Date

Landlord Approval

Landlord Approval Information

Because you do not own your home, we will need the landlord to approve this home modification.

Please download this form, fill in the information and ask the landlord to sign and date.

Once complete, the form can be emailed to HomeAccessNCT@als.org.

HOA Approval

HOA Approval Information

Because you are a member of a Home Owners Association, we will need the HOA to approve this home modification.

Please download this form, fill in the information and ask an approved HOA representative to sign and date.

Once complete, the form can be emailed to HomeAccessNCT@als.org.

Please contact your benefits administrator

Thank you for your application.

Thank you for your interest in the Maurer Heinsen Home Access Program. If you are a veteran, please contact your benefits administrator for information on home modifications.

Registered with ALS

Thank you for your application.

Thank you for your interest in the Maurer Heinsen Home Access Program. Only persons registered with The ALS Association are eligible for this program.

Thank you for your interest:

If you have met all the criteria, an ALS Association staff member will reach out to you.

PLEASE NOTE: This program is for anyone living with ALS/PLS/PMA and registered with The ALS Association and living in Iowa, Minnesota, North Dakota, South Dakota, or Wisconsin.

For more information about requirements/restrictions - click HERE

If you would like more information, please contact The ALS Association and speak to a staff member regarding these mandatory requirements.

Non-Home Owners info: Because you do not own your home, we will need the landlord to approve this home modification. Please download this form, fill in the information and ask the landlord to sign and date. Once complete, the form can be emailed to HomeAccessNCT@als.org.

HOA Info: Because you are a member of a Home Owners Association, we will need the HOA to approve this home modification. Please download this form, fill in the information and ask an approved HOA representative to sign and date. Once complete, the form can be emailed to HomeAccessNCT@als.org.

Iowa	Minnesota	North Dakota
South Dakota	Wisconsin	None of the listed States