By checking this box, I hereby grant permission, consent and authorization to share this information with the Area Agency on Aging District 7 (AAA7). The purpose of this Consent is to comply with any requirements, relating to the use and disclosure of provided information. The information obtained will be used and disclosed for the purposes of providing information and assistance, reporting, processing, administration, and/or determination of applying for programs and services.
Please mark the checkbox to indicate your acceptance.