Application for Modifications of Currently Owned/Leased Vehicle

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Have you applied to any other programs (state/federal/charitable organizations) for financial assistance in purchasing modifications to your currently owned vehicle?
Have you previously received any grant or financial award in purchasing your vehicle or/as well as modifications to your vehicle?
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By submitting this preliminary application, you certify that all statements and information above are true and correct and that you have read and understand the application guidelines.