Get Ca Santa Ana Police Department You Are Not Alone Program Service Request/waiver Form

Filling out the You Are Not Alone Program Service Request/Waiver Form is a straightforward process designed to help individuals who may need support while living alone. This guide will provide clear, step-by-step instructions for completing the form online to ensure it is filled out accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to retrieve the form and open it in your browser.
2. Begin by entering your full name in the 'Service Requestor Name' field. This should be the name of the individual requesting the service.
3. Fill in ‘Today’s Date’ using the format MM/DD/YYYY to specify the date you are submitting the application.
4. Provide the telephone number where YANA can reach you in the ‘YANA’s Telephone Number’ field.
5. Enter your complete address, including the ZIP code and the cross street/map grid, for verification purposes.
6. Indicate the start date and if applicable, the desired termination date for the service.
7. Select the preferred day(s) of visit by checking the days you would like a visit: Monday through Friday.
8. Provide your home phone number and indicate if a key is available by selecting 'Yes' or 'No'.
9. Fill in your work phone number, if applicable, and provide contact information for two emergency contacts. This includes their name, relationship to you, and their phone numbers.
10. List neighbors who can also be contacted in case of an emergency and provide their contact information.
11. Complete any additional fields related to the YANA program and ensure all required information is accurate.
12. Review the waiver section of the form carefully, and if in agreement, provide your signature along with the date. Ensure a witness also signs and dates where indicated.
13. After filling out all sections, save your changes. You can choose to download, print, or share the completed form as needed.

Start completing your application today to ensure the support you or your loved one needs is provided.