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Find similar grantsSenior Safety Program is sponsored by ND Assistive. Provides assistive technology devices to North Dakota residents aged 60 and over to enhance home safety and independent living.
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Senior Safety Application - North Dakota Assistive Senior Safety Application " * " indicates required fields Instagram This field is for validation purposes and should be left unchanged. Personal Information - Please use only the Applicant's Information Age (please enter a number) * What is your gender identity?
* Applicant Street Address * North Dakota Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Mailing Address (if different) North Dakota Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Reservation (if applicable) How did you hear about this program?
* Are you working with a ND Assistive Consultant? * If You are working with a ND Assistive Consultant please tell us who. ND Assistive now offers occupational therapy home safety evaluations to assist with device selection, setup and training.
Would you like more information about this service? What is your Ethnicity? * American Indian/ Native Alaskan Native Hawaiian/ Other Pacific Islander Non-Minority (White, non-Hispanic) What is your primary language?
* Do you feel socially isolated? * Are you currently enrolled in Medicare? * Are you currently enrolled in Medicaid?
* Are you currently enrolled in Northland PACE? * Priority Funding and Eligibility Please note that funding for this program is a limited financial resource through the Older Americans Act. Preference will be given to those who fall within the priority funding areas first.
I live in a rural area (not Bismarck, Grand Forks, or Fargo) * I am at risk of being placed in a skilled nursing facility * My income level is at or below the national poverty level (see chart below) * HHS Poverty Guidelines Table For each additional person, add Devices Requested * Please list the assistive safety devices you are requesting in order of importance. Please only put one device per line.
Please list any health concerns or disabilities that contribute to your need for the requested item(s). * How did you determine what assistive technology was appropriate for your needs? * (For example, My OT recommended.
I received a device demonstration from an Assistive staff member. Explain how this device(s) increases your safety/ independence on a day-to-day basis. * If you are requesting a toilet seat riser, shower chair, bathtub transfer bench, grab bar, or bed transfer handle, please provide the following information: Item If you are requesting a toilet seat riser, which shape of toilet do you have?
If requesting a shower chair, please check all that apply: The shower chair needs a backrest. The shower chair needs to have arms If requesting a shower chair, what is the inside measurement of the bathtub or shower where the chair will be used? If requesting a grab bar(s), please provide the length(s) and number of grab bars needed.
Standard, ADA-compliant grab bars are available in the following sizes: 12”, 16”, 18”, 24”, 30”, 32”, 36”, and 42”. Size needed is dependent on the space and the distance between studs (if installed horizontally). If requesting an emergency alerting system, do you have a landline?
Please note that the Senior Safety program only provides systems that require a landline. If you are not the applicant, is the applicant aware that equipment has been requested for them? * Should the devices be shipped to your home?
* If you want equipment shipped elsewhere, please provide the name and address to which the devices should be shipped Please note that not all vendors are able to ship to PO Boxes. Therefore, the street and mailing address should be provided.
North Dakota Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Are you completing this form on behalf of someone, or would you prefer we contact someone other than yourself regarding your request?
Alternate Contact Name Name of friend or family you would like us to contact instead. Alternate Contact Relationship/Title Alternate Contact Phone Number Alternate Contact Phone Type Alternate Contact Email Address Toll-free: 1. 800.
895. 4728 Mandan Local: 701. 258.
4728 Fargo Local: 701-365-4728 You may also email the Senior Safety Program at: seniorsafety@ndassistive. org This program is supported by funding from the United States Department of Health and Human Services, Administration for Community Living, Administration on Aging, and granted through the North Dakota Department of Human Services, Aging Services Division.
• Alerting Devices for Hearing Loss • Anti-Elopement Devices such as Wandering Alarms (device only) • Bed Rails (limited options) • Emergency Response Systems (device only) • Grab Bars (stainless steel only) • Medication Dispensers and Reminders • Personal Hearing Amplifiers • Shower Chairs (provide inside measurements of bathtub) • Toilet Safety Frames/Rails (limited options) • Toilet Seat Risers (limited options) • Tub Rails (limited options) • Tub Transfer Benches (provide inside measurements of bathtub) • Voice Amplifiers and Accessories Senior Safety Program Application [/et_pb_text][/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.
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Personal Information – Please use only the Applicant's Information Age (please enter a number) * What is your gender identity?
* Applicant Street Address * North Dakota Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Mailing Address (if different) North Dakota Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Reservation (if applicable) How did you hear about this program?
* Are you working with a ND Assistive Consultant? * If You are working with a ND Assistive Consultant please tell us who. ND Assistive now offers occupational therapy home safety evaluations to assist with device selection, setup and training.
Would you like more information about this service? What is your Ethnicity? * American Indian/ Native Alaskan Native Hawaiian/ Other Pacific Islander Non-Minority (White, non-Hispanic) What is your primary language?
* Do you feel socially isolated? * Are you currently enrolled in Medicare? * Are you currently enrolled in Medicaid?
* Are you currently enrolled in Northland PACE? * Priority Funding and Eligibility Please note that funding for this program is a limited financial resource through the Older Americans Act. Preference will be given to those who fall within the priority funding areas first.
I live in a rural area (not Bismarck, Grand Forks, or Fargo) * I am at risk of being placed in a skilled nursing facility * My income level is at or below the national poverty level (see chart below) * HHS Poverty Guidelines Table For each additional person, add Devices Requested * Please list the assistive safety devices you are requesting in order of importance. Please only put one device per line.
Please list any health concerns or disabilities that contribute to your need for the requested item(s). * How did you determine what assistive technology was appropriate for your needs? * (For example, My OT recommended.
I received a device demonstration from an Assistive staff member. Explain how this device(s) increases your safety/ independence on a day-to-day basis. * If you are requesting a toilet seat riser, shower chair, bathtub transfer bench, grab bar, or bed transfer handle, please provide the following information: Item If you are requesting a toilet seat riser, which shape of toilet do you have?
If requesting a shower chair, please check all that apply: The shower chair needs a backrest. The shower chair needs to have arms If requesting a shower chair, what is the inside measurement of the bathtub or shower where the chair will be used? If requesting a grab bar(s), please provide the length(s) and number of grab bars needed.
Standard, ADA-compliant grab bars are available in the following sizes: 12”, 16”, 18”, 24”, 30”, 32”, 36”, and 42”. Size needed is dependent on the space and the distance between studs (if installed horizontally). If requesting an emergency alerting system, do you have a landline?
Please note that the Senior Safety program only provides systems that require a landline. If you are not the applicant, is the applicant aware that equipment has been requested for them? * Should the devices be shipped to your home?
* If you want equipment shipped elsewhere, please provide the name and address to which the devices should be shipped Please note that not all vendors are able to ship to PO Boxes. Therefore, the street and mailing address should be provided.
North Dakota Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Are you completing this form on behalf of someone, or would you prefer we contact someone other than yourself regarding your request?
Alternate Contact Name Name of friend or family you would like us to contact instead. Alternate Contact Relationship/Title Alternate Contact Phone Number Alternate Contact Phone Type Alternate Contact Email Address Toll-free: 1. 800.
895. 4728 Mandan Local: 701. 258.
4728 Fargo Local: 701-365-4728 You may also email the Senior Safety Program at: seniorsafety@ndassistive. org This program is supported by funding from the United States Department of Health and Human Services, Administration for Community Living, Administration on Aging, and granted through the North Dakota Department of Human Services, Aging Services Division.
• Alerting Devices for Hearing Loss • Anti-Elopement Devices such as Wandering Alarms (device only) • Bed Rails (limited options) • Emergency Response Systems (device only) • Grab Bars (stainless steel only) • Medication Dispensers and Reminders • Personal Hearing Amplifiers • Shower Chairs (provide inside measurements of bathtub) • Toilet Safety Frames/Rails (limited options) • Toilet Seat Risers (limited options) • Tub Rails (limited options) • Tub Transfer Benches (provide inside measurements of bathtub) • Voice Amplifiers and Accessories [/et_pb_code][/et_pb_column][/et_pb_row][/et_pb_section] Take a short quiz to get personalized recommendations!
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According to the current listing, eligibility includes: North Dakota residents aged 60 and over who do not reside in a nursing facility. Confirm the full requirements in the official notice before applying.
Senior Safety Program is funded by ND Assistive. Verify program details on the funder's official page before applying.
This opportunity targets applicants in North Dakota. If your organization operates elsewhere, check the official notice for location requirements.
Start from the official opportunity page linked in this listing — it carries the sponsor's submission instructions.
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