Downloadable Forms & Applications
List of Services
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Application for Assistance (Indigent Status)List Item 1
Fill and send out this form if you wish to apply for assistance due to indigence.
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Application for Assistance (Disabled Status)aList Item 2
Fill and send out this form if you wish to apply for assistance due to disability.
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Consent and Authorization FormList Item 3
This form is for providing consent for a meeting/interview with the Association.
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Membership ApplicationList Item 4
Fill out and send this form to apply for membership to the Association.
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Financial Disclosure
This form is to be used when applying for assistance.
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Medical Equipment Loan Form
This form is to be used when equipment is on loan from the Association.
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Affidavit of Witnesses
Witness affidavit to verify a Releasor's ability to make a valid Release.
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Certification of Disability Form
Form to be filled out by a doctor to verify and certify applicant disability status
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Re-certification of Disability Form
Form to be filled out by a doctor to re-verify and re-certify applicant disability status
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Beneficiary Designation Form
This form is to be used when designating a beneficiary.
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Eyeglass & Dental Assistance Form
This form is to be used when a member is applying for eyeglass and dental assistance or reimbursement.
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Death Assistance Form
Form to be filled out by a family member or relative that is requesting for death assistance or reimbursement of the deceased member.