Free Roof Rescue Nomination

Please fill this form out in its entirety to submit your application for our Free Roof Rescue program.

You can also click here to print a paper copy to mail in your nomination.

  • Nominee information






  • We will consider all information provided when making our decision and will especially take into account family situation, financial situation, serious hardships, and physical disability.



  • Your information


    If you are nominating yourself, please skip this section. If you are nominating someone you know, please provide your contact information below.





  • References (Optional)

    Please provide us with contact information for up to three references we may contact to assist in our decision.
    References will only be contacted if nominee is a finalist for a free roof.