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Request Form(s)

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Click here for the 2024 Box Fan Request form

The Internal and External forms use the same link. You must have a QuickBase account (set up during training) to access the Internal version. Case Managers are asked to only use the Internal form.

  1. Press Submit New Request to open form

  2. User must indicate that they are at least 60 years old for the form to appear

  3. A few things to note:

    1. You must check “Are you homebound / unable to leave your home without assistance?” to request a delivery

    2. The Comments field only appears on the Internal form (i.e. for users who are logged in)

    3. A confirmation email will be sent to the Contact given Email Address on form submission. This will not be sent if no an email address is not given

  4. Once you click Save, you will be taken to a confirmation page. You can return to the landing page by clicking the FCOA logo in the top-left

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Make sure you are logged in! The top-right of the page will show your name if you are logged in.

Deliveries

As of May 15th, users who are “External” to the Office on Aging are no longer able to request box fan deliveries. Case Managers (i.e. “Internal” users) are the only ones capable of submitting delivery requests.

When an External user selects “Delivery” for Delivery Method, they receive text that instructs them to call the Office on Aging to confirm that they are homebound. A Case Manager will then submit a delivery request on the Senior’s behalf using the Internal form.

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Questions? Feel free to reach out to the our support team:

🌐 Submit a ticket online

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