Senior Referral Form

This form is for those who are age 60 and older and residents of Allegan County who would like to inquire or sign up for services provided by the senior millage. Currently, some of our services have wait lists. Submitting this form will place your name on the list for requested services, in the order received. As service units become available, you will be contacted; or you may call our office for more information.

Online Senior Referral Form