Caregiver Financial Aid

SHARE THE CARE
Taking care of loved ones suffering from Alzheimer’s and/or other related dementia disorders is a tremendous responsibility. These families face financial burdens, as well as daily challenges. With monies received from the Alzheimer’s State Funding, Cobb Senior Services provides these families with the financial assistance they need, through this exciting new voucher program.

The program is flexible in that caregivers can choose from a variety of services which best meet their individual needs. This includes, but is not limited to, respite (overnight), Senior Day Care, installation of safety equipment in home (grab bars, home alarms). All purchased services must in some way provide identifiable relief to the caregiver.

If you are in need of these types of services, please complete the application below and return it to the address provided. The Share the Care Coordinator will contact you to schedule an appointment.

Questions: Vel Pierre, Share the Care Specialist (770) 528-5351.

Funding for this program is provided through the cooperation of ARC, DHR, and Cobb County Board of Commissioners.

Regional Services Information:
The Aging Connection (404) 463-3333
Interested vendors may call (770) 528-5351 for an application.

Must be a Cobb County Resident.

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Caregiver Application Form
Caregiver Name:
Address:
Phone Number:
Social Security #:
Relationship to Family Member: (daughter, wife, etc)
Alzheimer's/Dementia Client Name:
Social Security #:
Date of Birth:
Medical Diagnosis:
Date of Diagnosis:
Medications Taken:
Physician's Name:
Physician's Address:
Physician's Phone Number:
List of Services desired:	Respite (overnight) Daycare Home Adaptations Other
In some cases other grant money may be available for other services. This would be discussed at the time of the assessment. Must be a Cobb County Resident. Services provided by pre-approved vendor list only. Vouchers may be awarded on a cost share basis. No cash is exchanged between Client and vendor. Questions? Vel Pierre, Share the Care Specialist (770) 528 – 5351 Please print & mail this form to: Share the Care 32 N. Fairground Street Marietta, GA 30060                                 OR Click below to submit online << Previous Page