Important Forms & Documents

Important Forms & Documents

PLEASE BE SURE TO SCROLL TO BOTTOM OF THIS PAGE WHERE YOU CAN ACCESS ALL DOWNLOADABLE FORMS
 

Contract signCouncil on Aging Code of Conduct - The Swansea Council on Aging has adopted a "Code of Conduct" that outlines the requirements we all must meet at the center.  This Code was created to protect all who frequent the center or use COA programs/services and for the benefit and well-being of everyone, it must be adhered to at all times.  Safety, dignity and respect are always a must at your center.

I agreeCouncil on Aging Participation Agreement - All of the programs and services provided are designed to meet the needs and wishes of our participants.  We hope your every visit to our center is a positive and enjoyable experience!  It is with that in mind that all understand their responsibilities and the expectations associated with participation at the Swansea COA.  SAFETY is always our top priority.   For this reason a Participation Agreement must be reviewed and be signed by all who wish to participate at the center.  A copy of this Agreement is available for viewing and/or download by scrolling at the bottom of this page.

Fuel Assistance  Fuel Assistance Program & Guidelines - The program assists eligible households pay their heating bills during the winter season or until benefits are exhausted. Clients receive various discounts such as telephone discounts, electric discounts, and gas and oil discounts.  If you received fuel assistance last year, a renewal application will be mailed to you.  For new enrollees, applications will be made available at the Swansea COA, 260 Ocean Grove Avenue. If you wish to apply for the first time, or require help with the renewal process, please call the Swansea COA (508) 676-1831 for more information or a list of required documentation. Please note that applications will not be mailed to new applicants but may be filled out at the Swansea COA. Note: This is a Citizens for Citizens, Inc., program and all applications will be forwarded to them for processing.Silver Alert - The Swansea COA and Police Department partner for the Silver Alert Program to alert public safety departments when an adult with memory impairment is reported missing.  Fill out a detailed form about your loved one now.  The information is kept on file and ONLY shared with Emergency Responders should your loved one go missing.

Emergency ID CardMedical ID Wallet Card - Carry your Emergency ID Card with you.  Fill out the attached form.  Return it to a staff member or send to the Swansea Council on Aging at 260 Ocean Grove Avenue, Swansea, MA 02777.  Our Administration Staff will prepare your card and notify you when it's ready.  It's that easy! There is no charge for this service.  

Medicare Part D Plan Finder/Data Form - Current Medicare Part D beneficiaries and new enrollees are encouraged to a review of their medications and Part D Drug Plan each year.  Use this form before scheduling your meeting with a SHINE (Serving Health Insurance Needs of Everyone) Counselor.

Special Needs Assistance Request Form- Emergency Help - Imagine being trapped in your home with no electricity, telephone service or heat.  What would  you do without power during a hurricane or blizzard or in the days that follow?  Fill out this form to tell us what your special needs are.  Return it to the COA and it will be shared with Emergency Responders in the event of an emergency.

Clients of Bristol Elder Services, Inc. Coordination of services is important but your identity and information is private.  If you are a Bristol Elder Services, Inc., client and would like to have your information shared with the Swansea Council on Aging, your authorization will be required