Begin the Application Process

The Intake Specialist can provide you with information on support services available to allow one to remain safely at home. Intakes for all the programs can be done over the telephone or through a scheduled appointment in the office.Marsha

In order to be referred to the proper program, you will be asked, among other necessary information, to provide information on your income and assets. If you are home-bound, an outreach visit can be done.

Information packets can be mailed to you with an explanation of the programs, as well as information on the financial criteria that needs to be met to qualify for services.

If you do not meet the criteria, the Intake Specialist has a wealth of information on other resources available in the community. If someone needs to be placed in a facility from their home, the Intake Specialist is the person to contact so the necessary steps can be taken.

Please answer the questions below and click ‘Submit’ to begin the application process. We will contact you to schedule a follow-up interview after your application is received. Please be assured that your information is safe and will not be shared with a third party. Please feel free to call us if you have any questions. We are here to help.

Date (mm/dd/yyyy): *

Name: *

Telephone (XXX-XXX-XXXX): *

Full Address: *

Mailing Address (if different):

Preferred date and time to call to continue application process:

Services you are interested in:

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Download Application

Other Ways to Apply

Over the phone
814.723.3763 or 1.800.281.6545

Print & mail application
Experience, Inc. 905 4th Ave. Warren, PA 16365

Schedule an appointment.
Call today to make an appointment.

  • Date of Birth
  • Social Security Number
  • Marital Status
  • Primary Physician & Address
  • Emergency Contact Information
  • Medical/Health Issues
  • Insurance Information
  • Pension Information
  • Cash Value Life Insurance (CDs, stocks, bonds, retirement, IRAs)
  • Home Owner Information
  • Assets