Senior Ark

Name of Applicant *

Age (must be over 65) *

Phone *

Email

Mailing Address *

Income Guidelines

Persons in household --> Household Income 1 --> $24,120 2 --> $32,480 3 --> $30,840 4 --> $49,200 5 --> $57,560 6 --> $65,920 7 --> $74,280 8 --> $82,640

Is the household income below the income guidelines? *

Yes

No

Is the household going through change or crisis (divorce, death, health issues, job loss, other) *

Yes

No

Are you disabled? *

Yes

No

Are you a Veteran? *

Yes

No

Select a category that best describes the need: *

Interior Home Improvement

Exterior Home Improvement

Social

Transportation

Describe Service or project needed *

If the project is for home improvement do you:

Rent

Own

Have you researched/contacted service providers to determine cost?

Yes

No

If yes, please list the name(s) of the Service Provider(s) and the cost estimate: *

Is the service or project an emergency?

Yes

No

What is your plan for obtaining the total amount of funding needed to proceed?

Service Provider Information

All grant awards are made payable directly to the service provider.

Service Provider *

Contact Person

Phone

Address

City

State/Province

Zip/Postal

Country

Do you need assistance in determining a service provider?

Yes

No

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Things happen in life we can’t always plan for. Be that challenges or opportunities. The Senior Ark Fund is here to help.

Fill out the online application below or download the printable application.

Income Guidelines

Service Provider Information

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