Apply to the Friendly Programs

ALL INFORMATION GIVEN IS CONFIDENTIAL.

*Indicates required field.

Which Program are you interested in?
Are you requesting this service for yourself?
Applicant information
Emergency Contact Info
Do you have voicemail?
Can you send and receive text messages?
Are you a Cal Fresh recipient?
Are you a Veteran?
Do you drive?
Are there pets in the home?
Do you smoke or live with smokers?
Demographic Questions
Your Health
Mobility
Hearing
Are you able to hear over the phone?
Vision
Do you have memory issues?
How often do you feel left out?
How often do you feel that you lack companionship?
How often do you feel isolated from others?
Do you prefer a man or a woman visitor, or no preference?
Would you consider a volunteer who visits with children?