Nineveh Outreach Auto Care Application

*Before completing the application, please answer the following questions:

 Is your vehicle mileage under 200,000? Y N
 Is the vehicle operational? Y N (Only vehicles that can be driven to the shop will be accepted. No towed vehicles will be accepted for the clinic).
 Is this vehicle your primary source of transportation? Y N

*If you marked N for any of the above, you have not met the requirements for our service. An application will not be considered at this time.
*If you marked Y for all the 3 questions, you may continue with the application process.

Once this application is received in the office, it will be forwarded to our review team for determination of eligibility. Please fill in the information as accurate and complete as possible, as an incomplete application may slow the process of the review.

You will receive a response within 2 weeks of the date of review.