Resource Center - Transportation
This is the provider referral form for Hospice of Anchorage's grant program for assistance with transportation. This program is open to Alaskans over the age of 60 who are experiencing financial hardship and are in need of additional support to be able to get to/from medical appointments and obtain their needed medications. A healthcare provider is required to send this referral in for the individual to be considered for the grant, no self referrals will be accepted. Each assistance program is subject to available funding and has limitations for use by person. Referrals are reviewed every other Wednesday morning, and recipients will generally be notified by the end of the week. Please call Hospice of Anchorage at 907-561-5322 if you have any additional questions.
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Is the potential recipient 60 or older? *
If no, please be aware they will not be eligible for this assistance program. Due to funding limitations, there are no exceptions for this at this time. Please consider calling 211 to see if there are any additional resources available.
I have spoken with the potential recipient about this referral and they have given permission that I seek this support on their behalf.
Clear selection
If no, please pause and discuss with the potential recipient before proceeding with this application.
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This form was created inside of Hospice of Anchorage.