Community Advocacy Project

Senior Medi-Benefits commits part of its time and resources to helping California's under-served elderly and disabled individuals with the no-cost Community Advocacy Project. The criteria to be accepted into the CAP program are low income, low assets, and type of problem you are having.

PRIVACY STATEMENT – Senior Medi-Benefits NEVER shares any private, personal information with outside parties. All correspondence and submissions are 100% confidential.
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START YOUR APPLICATION by supplying information about the applicant:

I am filling out the e-form for: myself another

Age:
Gender: female male
County of Residence:
State of Residence:
Marital Status:
Category of Problem:
Living Situation:
Short Description of Issue:

The following questions will help Senior Medi-Benefits determine if you are eligible for our community advocacy project:

Estimated Monthly Income:
Estimated Monthly Expenses:
Estimated Financial Assets

WE NEED THE FOLLOWING INFORMATION to be able to contact you.

Email Address: or
Phone Number:
* Your Name: