APPLICANT FINANCIAL AND MEDICAL HARDSHIP DISCLOSURE AGREEMENT:

Stepping Up For Seniors (“SUFS) has adopted a policy of screening applicants to determine the financial and medical hardship of each applicant.  All information is held confidential and remains private as your information will not be shared with any entities that are not related directly to SUFS.

Documents may be required to submit to SUFS if requested to include, but not limited to, any medical and/or financial information.   A home assessment may also be required during the application process.

By accepting the terms and conditions of this Disclosure, the applicant:

  1. Gives full financial and medical condition disclosure;

  2. Must be open to discussing long-term plans that will assist in the current situation, such as ALTCS or VA;

  3. Acknowledges that SUFS is a short-term arrangement and can be evaluated for continuance of assistance;

  4. Grants SUFS permission to verify any and all information provided in the application;

  5. By submitting this application, this certifies that the applicant’s information that is provided is true and complete;

  6. Acknowledges that preliminary screenings may disqualify you from SUFS assistance.

  7. Acknowledges if any terms and conditions are not met, the application will be rejected automatically.

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