COVID-19 Elderly Emergency Supplies
For our Seniors ages 70+
Email *
Are you between the ages of 65-110 years of age? *
Are you currently employed?
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Phone Number
Include first and last name of applicant. This is a need based program, please elaborate and describe need:
Do you/or the applicant have family members who are caring for you during COVID-19
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How did you hear about this program?
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Physical Directions to Home:
Navajo Language Prevention and Precautions
Are you exhibiting symptoms of cough, fever, and trouble breathing. We urge all patients to stay home and self-isolate if you only have MILD or Moderate symptoms and call your doctor if you are experiencing SEVERE symptoms. Do you or anyone at your residence exhibit any of these symptoms?
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Are you currently experiencing shortness of breath or trouble breathing?
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