Membership Application

Thank you, in advance, for completing this application to connect with A Little Help. Once submitted, you will receive a call within 10 business days from our Membership Team to discuss your application.

Once approved, our new members will receive an in-person Warm Welcome visit to further assess your needs and to share more information about our organization. Our volunteers support older adults ages 55+ in Denver, Jefferson, Larimer, Mesa, and parts of Douglas, Arapahoe, Adams and Broomfield Counties.

If you are unsure of the types of help our volunteers can offer, please take a look at our how we help page.

Below is a list of basic eligibility criteria in order to become a member with A Little Help.

  • Age: Individual is 55+ years of age
  • Location: Individual lives in an area serviced by A Little Help
  • Residence: Individual has a permanent residence
  • Need: Individual has needs that fall within the scope of A Little Help’s services. Please visit our list of tasks we can help you with.
  • Communication: Individual is able to verbally communicate by oneself over the phone or by email

If your situation falls within these parameters, please continue to fill out our application below. If you have further questions, please visit our website.

FIRST APPLICANT
NOTE: Any reference to "you", "your", "yourself" in this form apply to the applicant to receive ALH service. If you are filling out this form on behalf of the applicant to services, make sure you fill out the fields related to the applicant, marked as "you" / "your" with information about the applicant themselves.
About You
How should we address you?
Postal Address
PO Box
Contact Details
A Little Help may occasionally send text messages to your mobile phone to communicate program and fundraising events. If you do not wish to receive text messages, including messages to confirm an activity request, or that a volunteer has accepted your request, please check the box below.
Unfortunately, if you are not able to communicate by phone or email with our office team or our volunteers, then you do not qualify to receive help and we have to deny your application.
Personal Details
Tell us more about yourself

All of the questions in this section apply exclusively to the person applying for ALH services, identified in the section above.

Your Personal Health
If other, please detail below:
Please check the conditions that apply to you.
Your Physical Environment
If other, please enter below:
Your Access to Technology
Your Financial Situation
YOUR HOUSEHOLD
Your Partner
How should we address your partner?
Your Partner's Contact Details
A Little Help may occasionally send text messages to your partner mobile phone to communicate program and fundraising events. If you do not wish to receive text messages, including messages to confirm an activity request, or that a volunteer has accepted your request, please check the box below.
Your Partner's Personal Details
Your Partner's Personal Health
Your Partner's use of Technology
Financial Situation
If there are more than 2 people in addition to you, and maybe your partner, in the house, you will have the opportunity to share their details with us when we call you.
Household Member 3
A Little Help may occasionally send text messages to members of your household to communicate program and fundraising events. If you do not wish to receive text messages, including messages to confirm an activity request, or that a volunteer has accepted your request, please check the box below.
Household Member 4
A Little Help may occasionally send text messages to members of your household to communicate program and fundraising events. If you do not wish to receive text messages, including messages to confirm an activity request, or that a volunteer has accepted your request, please check the box below.