Funding Application Intent for Area Agency on Aging PSA2 -- Older Americans Act (Title III) and Senior Community Services (SCS) funded services for the 2027–2030 contract period-DUE May 22, 2026

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1. Please provide the organization name.

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2. Please provide the organization address.

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3. Please provide the contact telephone number.

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4. Please provide the primary contact person's name.

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5. Please provide the contact email address.

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6. Type of Agency

Governmental

For Profit

Non Profit

Minority Agency

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7. Select the fund/service you are interested in. Select all that apply.

Access – includes information & assistance, case management, and outreach.

In-Home – homemaker, personal care aide, respite visiting, adult day care, home maintenance, transportation, and supportive services.

Care Coordination
*Senior Community Services

Home Delivered Meals

Congregate Meals

Caregiver Support
*Title III-E National Family Caregiver Support Program

Evidenced Based Programming
*Title III-D

Other (please specify)

Question Title

8. If In-Home service was selected above, please check all services your organization intends to provide.

Homemaker

Personal Care aide

Respite Visiting

Adult Day

Home maintenence

Transportation

Supportive Services

Other (please specify)

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9. Type of Provider

Community Action Agency

Senior Center

Transit System

Long Term Care Facility

Legal Services Corporation

County Department

Other (please specify)

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10. Does your agency have local office in the county you intend to serve?

Yes

Other (please specify)

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11. If applicable, does your agency have Board approved policies and procedures that support your proposed Care Coordination Program?

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12. Interested Agency understands that outreach, intake and assessment are the responsibility of the Agency that is awarded a contract for the services for which bid(s) are being submitted?

Yes

Other (please specify)

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13. Please provide a narrative explanation of intentions.

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14. Select the county or counties where services will be delivered. Select all that apply.

Champaign County

Clark County

Darke County

Greene County

Logan County

Miami County

Montgomery County

Preble County

Shelby County

Funding Application Intent for Area Agency on Aging PSA2 -- Older Americans Act (Title III) and Senior Community Services (SCS) funded services for the 2027–2030 contract period-DUE May 22, 2026

Question Title

* 1. Please provide the organization name.

Question Title

* 2. Please provide the organization address.

Question Title

* 3. Please provide the contact telephone number.

Question Title

* 4. Please provide the primary contact person's name.

Question Title

* 5. Please provide the contact email address.

Question Title

* 6. Type of Agency

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* 7. Select the fund/service you are interested in. Select all that apply.

Question Title

* 8. If In-Home service was selected above, please check all services your organization intends to provide.

Question Title

* 9. Type of Provider

Question Title

* 10. Does your agency have local office in the county you intend to serve?

Question Title

* 11. If applicable, does your agency have Board approved policies and procedures that support your proposed Care Coordination Program?

Question Title

* 12. Interested Agency understands that outreach, intake and assessment are the responsibility of the Agency that is awarded a contract for the services for which bid(s) are being submitted?

Question Title

* 13. Please provide a narrative explanation of intentions.

Question Title

* 14. Select the county or counties where services will be delivered. Select all that apply.

1. Please provide the organization name.

2. Please provide the organization address.

3. Please provide the contact telephone number.

4. Please provide the primary contact person's name.

5. Please provide the contact email address.

6. Type of Agency

7. Select the fund/service you are interested in. Select all that apply.

8. If In-Home service was selected above, please check all services your organization intends to provide.

9. Type of Provider

10. Does your agency have local office in the county you intend to serve?

11. If applicable, does your agency have Board approved policies and procedures that support your proposed Care Coordination Program?

12. Interested Agency understands that outreach, intake and assessment are the responsibility of the Agency that is awarded a contract for the services for which bid(s) are being submitted?

13. Please provide a narrative explanation of intentions.

14. Select the county or counties where services will be delivered. Select all that apply.