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, none of our services have wait lists. Submitting this form will start the referral process. Our office will receive your request and process your referral. After the referral is processed, it will be sent to one of our service providers who will contact you to get the service you requested set in place. All referrals are processed in the order they were received.  

Online Senior Referral Form