Aging Grants Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character
Friends 60 years or older in financial need may apply for grants to assist with basic needs or to make it possible to live in communities, or to remain in their own homes.
Your data is exclusively used for your aging grant application. It will not be shared.
If questions arise while completing this application, please contact Sheila Sorkin, Aging Support Coordinator, at ssorkin@pym.org or grants@pym.org.




Submitter Contact Information








Applicant Information





Residence Mailing Address





Residence Information










Include property taxes and insurance, if applicable.


Request Information





If approved, please submit a receipt to grants@pym.org when funds are spent.




Please have your clerk email grants@pym.org to acknowledge your application.

Applicant's Monthly Income






















Liquid Assets








Applicant's Monthly Expenses


Gas, Electric, Water



(Co-pays, supplies, insurance, medicine)











Documentation

For First-Time Applicants


Care Coordinator




Financial Power of Attorney






If you did not upload your financial POA, please send a copy to grants@pym.org when complete.