Make Referral
Donate
Menu

The Middle Alabama Area Agency on Aging provides supportive resources and services to individuals residing within Blount, Chilton, Shelby, St. Clair, and Walker Counties in Alabama. In addition to these counties, M4A also provides the Senior Community Service Employment  Program (SCSEP) for Jefferson County. This is the only program that M4A currently offers in Jefferson County. 

Please note that there are 12 other agencies across Alabama’s Aging Network that cover the remaining counties throughout the State. For more information about these agencies, please visit the statewide map located HERE.

Please use the form below to begin the referral process.

INFORMATION ON THE INDIVIDUAL NEEDING HELP

"*" indicates required fields

Name*
MM slash DD slash YYYY
Address
Services Needed
Person Making the Referral
Name
This field is hidden when viewing the form
Referral Consent
Has client been made aware of and consented to referral being placed to their local Area Agency on Aging/M4A for services?

"*" indicates required fields

Name*
MM slash DD slash YYYY
Address
Services Needed
Person Making the Referral
Name
This field is hidden when viewing the form
Referral Consent
Has client been made aware of and consented to referral being placed to their local Area Agency on Aging/M4A for services?