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Neighbors Helping Neighbors Program -
Application for Assistance

VILLAGE OF ROMEOVILLE
Description:
The Village of Romeoville’s Neighbors Helping Neighbors program provides assistance to residents of the community with the help of volunteers. Throughout the year, we receive several calls from our residents who need help mowing their lawn, shoveling their driveway or completing minor home repairs. Many individuals in our community, especially the elderly or physically challenged, cannot meet these basic needs without some help.

This program is based on volunteer availability. It is not intended as a permanent resource, but on an as needed basis only.

Please complete the application to request assistance through the Neighbors Helping Neighbors Program.

For more information or if you have questions, please call Dawn Caldwell at Village Hall at 815-886-0279.
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Name:
Address:
Phone Number:
Best time/day to reach you:
Are you a Senior Citizen?
1. Yes
2. No
Are you a Veteran?
1. Yes
2. No
Do you have a medical reason or disability preventing you from completing the work yourself?
1. Yes
1. No
Have you exhausted all other resources for assistance (family, friends, etc.)?
1. Yes
1. No
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Please indicate the nature of the work needed:
If other, please describe:
Do you have materials needed for the project?
1. Yes
2. No
Do you have the financial means to purchase materials needed?
1. Yes
2. No
Have you been cited for a code violation?
1. Yes
2. No
Check to indicate if you have read the Service Recipient Agreement.
1. Yes
2. No
Signature:
By typing your name into this field you authorize the Village of Romeoville to consider this an electronic signature.
Date:
Date:
Please upload the signed Waiver and Release:

Leave This Blank: