Recipient Information

To help make sure supplies reach those who truly need them, all applications must be completed by a representative (caregiver, professional, or support person) on behalf of the recipient.

We are unable to accept forms filled out by applicants themselves.

Representatives will also handle pick-up of the products from our location once the order is ready.

Eligibility Information

Additional Information

This program is designed to assist seniors in urgent situations where other resources are not available, such as a lack of funds, no family support, or no other means of obtaining essential supplies. 

Your submission will be sent to our review board and you will receive a follow-up email.