SnowSafe Neighbors Program Recipient Application

Name(Required)

First Last

Name of person filling out application if submitting on behalf of recipient

Address(Required)

Street Address Zip Code

Email(Required)

Email of person if submitting on behalf of recipient

Phone(Required)

Phone number of person if submitting on behalf of recipient

To be eligible to receive snow removal assistance, the individual must meet the following (please mark all that apply):(Required)

be a resident of the City of Happy Valley

be over 60 years of age OR a person who is physically challenged

have limited financial resources

be unable to shovel his or her sidewalk and have no other resources to remove it (i.e. neighbors, friends or a hired service)

City Hall