Provider Application

New Providers Application Process for Choice, SSBG and Title 3 Programs

  • Complete new provider application packet and return as indicated on the packet checklist.
  • New providers must currently be serving at least one client under another funding source to be considered for application.
  • The establishment of a contractual agreement provides no guarantee of referrals for service delivery.
  • Request for a complete application packet, including the contract, and any questions can be directed to:
Beth Krudop, VP of Administration
AIHS
8101 W. Jefferson Blvd.
Fort Wayne, IN 46804
Or via email at info@agingihs.org.

Provider Application

New Providers Application Process for Choice, SSBG and Title 3 Programs

  • Complete new provider application packet and return as indicated on the packet checklist.
  • New providers must currently be serving at least one client under another funding source to be considered for application.
  • The establishment of a contractual agreement provides no guarantee of referrals for service delivery.
  • Request for a complete application packet, including the contract, and any questions can be directed to:
Beth Krudop, VP of Administration
AIHS
8101 W. Jefferson Blvd.
Fort Wayne, IN 46804
Or via email at info@agingihs.org.