CONTACTING OUR OFFICE IS EASY

Call our office at:
815-626-7707
or toll free 1-800-645-2859

or Write to:

Whiteside County Senior Center
1207 West Ninth Street
Sterling, Illinois 61081

You can also fill out this form to receive more information via email:

NAME

ADDRESS

CITY

ZIP

PHONE

EMAIL

GENDER: Male Female

DATE OF BIRTH (mm/dd/yyyy)

HOW DID YOU HEAR ABOUT OUR AGENCY?

Please check all the following benefits/services/pamphlets which you are interested in learning more about:
Time Was Adult Day Care
 Congregate Meal Sites
Home Delivered Meals
 Senior Housing Options
Home Safety
 Homemaker Services
Employment
 Caregiver Support Programs
Transportation
 Case Management
Elder Abuse / Neglect
 Health Promotion
Legal Assistance
 Prescription Drugs
Heating / Electric Bills
 Financial Assistance Program
Other, please specify

Certain programs have income/assets eligibility requirements: In order for us to determine which programs you qualify for, you will be asked to disclose some basic financial information when visiting:
• Total Household Gross Monthly Income
• Savings
• Investments

1207 West Ninth Street • Sterling, Illinois 61081 • (815) 626-7707 • 1-800-645-2859 • Fax (815) 625-0155