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GVAS Contact Form


I am interested in receiving additional information on the following services:

Temporary Monetary Assistance Program (assistance with rent/shelter, utilities, prescriptions, limited household goods and specialized dietary needs, or other necessities of daily living (130% of Federal Poverty requirement).
Case Management Program advocacy and referrals, home visits, evaluation of service needs for seniors who are frail, homebound, or living with chronic illness, which limits their ability to carry out normal activities of daily living.
Volunteer opportunities include training to provide in-home support services to low-income adults (such as grocery shopping & errands, caregiver relief, visiting); or volunteering for special events or in-office services.
Personal Budgeting Assistance Program helps elderly, low income individuals with setting-up a budget, assistance with sorting and organizing bills for payment.
Contact Information
Name: Email Address:
Daytime Phone: Evening Phone:
Address:
Street City State    Zip
Please Contact me by:
E-mail (must provide e-mail address above)
Regular Mail
Day Telephone Number (best time to call: )
Night Telephone Number (best time to call: )
I am interested in volunteering for the following programs:
Provide shopping & errands, caregiver relief, visiting
Personal Budgeting Assistance Program
Seasonal/Holiday Programs (Back-to-School or Holiday Program)
How did you discover our website?
Newspaper
TV or radio
GVAS brochure, letter
GVAS business card
GVAS Website
Other:
This information will be sent to gvasoffmgr@qwest.net