Senior Needing Assistance
Please check the monthly income level that applies to you
Asset Level (Cash Assets)
If requested, are you willing to provide documentation to prove eligibility for requested assistance or service?
Please explain your situation to help us better understand how to serve you? Include any preferences for a preferred provider or agency for assistance requested.
Have you sought assistance from or are you currently receiving assistance from another organization? If yes, please list here
Contact information of family member, caregiver, or professional making request; if applicable.
Agreement and signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if accepted as a recipient of assistance, any false statements, omissions, or other misrepresentations made by me on this application may result in loss of future assistance from SOAR.
It is the policy of SOAR, Supporting Older Adults through Resources, Inc. to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. SOAR is a registered 501 © 3 nonprofit organization established to offer assistance to Frederick County seniors aged 65 and above.
We are honored to be able to give your application consideration and will respond to you as soon as possible.