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Senior Aid Submission Portal

A formal gateway for law enforcement, EMS, and the public to request compassionate aid and visitation for isolated seniors.

Aid Submission Form
Please provide as much detail as possible to help our volunteer network prepare for the visit.

Senior Information

Submitter Information

Select the entity submitting this information.

Check if you would like the foundation to follow up with the senior after the initial visit.

Information submitted is kept confidential and used solely for the purpose of coordinating volunteer visitation and aid.

Our Commitment to Privacy

We understand the sensitive nature of the information provided by law enforcement and the public. The St. Sampson Senior Aid Foundation is dedicated to handling all senior aid requests with the utmost confidentiality, respect, and ethical care.

Secure Transition of Information
When law enforcement officers submit welfare check details through our portal, that publicly available FOIA data is immediately secured within our system. We ensure a seamless, protected handoff from emergency services to our compassionate care network, guaranteeing that sensitive details are only accessible to authorized foundation personnel coordinating aid.
Ethical Record-Keeping
All submitted information—including names, addresses, and specific needs—is maintained in strict confidence. Our record-keeping practices are designed to protect the dignity of every senior we serve. Data is utilized exclusively to match seniors with appropriate volunteer companions and to facilitate necessary spiritual and basic needs support.