Free Bike Program Application Online ApplicationImportant Information - Letter of Reference required In addition to completing this online application, a letter of reference explaining how you will benefit from receiving a bicycle will need to be e-mailed, mailed, or dropped-off to Urban Bike Project. An application will not be considered complete until we have this letter of reference. Please go to the Free Bike Program page if you would like to print, mail, or drop-off your application, instead of using this online application form. A sample letter of reference can also be found on that page. Details and Eligibility APPLICANTS MUST LIVE IN WILMINGTON, DE AND SURROUNDING COMMUNITIES. See full eligibility requirements on the Free Bike Program page. *Fields marked with an asterisk are required.Personal InformationFirst Name *Last Name *Street Address *Apartment # City *State *Zip Code *Age *Height *Needed for bike fit / sizing.Gender *MaleFemaleReferred By (organization): *Contact Information Who should we contact when the bike is ready to be picked up? We need a phone number or email address or both.Contact Name *Contact Phone # Contact Email Address General InformationRace: Please select all that applyPrefer not to answerAfrican AmericanAmerican Indian/Native AmericanLatino/HispanicWhite/CaucasionOtherAre you homeless or living in transitional housing? NoHomelessTransitional HousingOtherSources of Income: Please check all that applyAFDC/TANF (Aid to Families with Dependent Children/Temporary Assistance for Needy Families)GA (General Assistance)SS (Social Security)SSI (Supplemental Security Income)SSDI (Social Security Disability Insurance)SSDI (Social Security Disability Insurance)WagesUnemploymentNo sources of incomeOtherDo you participate in any of the following programs? Check all that applyFood StampsMedicaidProbationWork ReleaseAnnual household income: Please tell us how much money you make in a year. If you do not know, give your best guess.Household size Please tell us how many people your income supports, including yourself and your children.Self-certification I certify that all information entered is true to the best of my knowledge. I certify that my household income is at or below the number listed for my household size: 1 - $21,257 2 - $28,694 3 - $36,131 4 - $43,568 5 - $51,005 6 - $58,442 7 - $65,879 8 - $73,316YesNoWhich forms of transportation do you currently use? Check all that applyOwn a carBus/public transportationBicycleRide from family/friendsWalkOtherHow would you use your free bicycle? Instructions Urban Bike Project will provide the following accessories with the bicycle, unless requested otherwise or lack of resources: • Lights (legally required at night in Wilmington) • Lock • HelmetIf available, would you like any of the following items to come with your bike? FendersRear rackIs there anything else you would like to tell us about? Would you like to sign up to our email list to receive notices about events and other announcements? YesNoAre you interested in volunteering with Urban Bike Project? Our volunteer orientations occur the first Monday of every month, 6:30 pm at our shop. YesNoLetter of Reference *Please tell us how you will be providing your letter of reference. Lack of a reference letter is the main reason many online applicants do not get approved for a free bike.E-mail to urbanbikeproject@gmail.com (must be from official referral agency/organization email address)Mail to Urban Bike Project, P.O. Box 729, Wilmington, DE 19899Drop off to UBP during our Open Shop program - Tuesday 6:30PM-9PM or Thursday 6:30PM-9PM VerificationPlease enter any two digits with no spaces (Example: 12) *This box is for spam protection - please leave it blank:
