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.

"*" indicates required fields

Name*

First Last

Date of Birth*

Age*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County*

Phone*

Services Needed

Notes

Person Making the Referral

Professional

Caregiver

Family/Relative

Friend

Prefer not to answer

Name

First Last

Phone

Additional Information (if needed)

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Make a Referral

INFORMATION ON THE INDIVIDUAL NEEDING HELP

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