Home Delivered Meals Intake Form
Download and complete the intake form for home-delivered meal services.
Caregiver Support Services Form
Request caregiver support services including training, counseling, and assistance.
Elderly Home Pre-Tenancy Application
Application for eligibility to reside in the Elderly Home.
Transportation Request Form
Use this form to request rides to the Senior Center, medical appointments, or approved trips.
Senior Center Building Use Request Form
Request permission to use Senior Center facilities for events or meetings.
Release of Information (IHS-810)
Authorizes sharing of protected health information with approved agencies.
Client Rights & Responsibilities
Outlines participant rights and responsibilities in Senior Services programs.
Text Message Authorization Form
Enroll in SMS notifications for updates and program communications.
2026 Federal Poverty Guidelines (FPL)
Used to determine eligibility for certain services.
Elderly Home House Rules
Rules and expectations for residents of the Elderly Home.
Elderly Home Policies & Procedures Manual
Detailed operational policies for housing services.
Workforce Assessment Report
Community workforce and healthcare needs assessment.
COVID Oral History / Pandemic Screening Document
Community historical and health documentation project.
If you need assistance locating a form, completing an application, or learning more about available programs, our staff is here to help.
Hualapai Senior Services Center
587 Canyon View Drive
Peach Springs, Arizona 86434
Phone: (928) 769-2375
Email: elderly@hualapai-nsn.gov
Hours:
Monday–Thursday
7:00 AM – 5:00 PM
