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Accessibility Modification-Request for Reimbursement

The form below allows you to email the DAIL Shared Living Workgroup a notification that you have uploaded your request for an Accessibility Modification Reimbursement into the DAIL Housing Portal and is ready for DAIL's review.

For additional information about the DAIL Housing Accessibility Modification Reimbursement process and forms please use this link: DAIL Housing Accessibility Modification Reimbursement.

Fields marked with a red star * are a required field.

When entering your phone number please include the Area Code.  List your phone number in the following way:  802-123-4567.
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