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Forms and Information
Quarterly reports are due 30 days after each quarter ending:
1st quarter - July 1 - September 30
2nd quarter - October 1 - December 31
3rd quarter - January 1 - March 31
4th quarter - April 1 - June 30
Quarterly reports may be mailed, faxed or emailed to the grant administrator listed below. Please mail, fax or scan original signature pages.
Grants and Contracts Support Team
P.O. Box 110650
Juneau, AK
99811-0650
Fax: (907) 465-3419
- SIH and NFCSP:
Marlyn Carrillo, Grants Administrator
Phone: (907)465-3026 - Adult Day:
Stephen Bower, Grants Administrator
Phone: (907)465-6924
HCB Senior Grants Program Manual
Adult Day Services
- FY12 ADS Quarterly Report Narrative (Word and PDF)
- SAMS HCB Registration Form
Senior In–Home Services
- FY12 SIH Quarterly Report Narrative (Word and PDF)
- FY12 SIH EBSC - CFR2 Form (Excel)
- SIH Grant Care Coordination Assessment
- SAMS HCB Registration Form
- SIH Supplemental Services Request Form
National Family Caregiver Support Program
- FY12 NFCSP Quarterly Report Narrative (Word and PDF)
- FY12 NFCSP EBSC - CFR2 Form (Excel)
- NFSCP Registration Form
- NFCSP Sample log for Group Activities
- NFCSP Sample log for Consumer Services
SAMS (Social Assistance Management Software)
Senior In-Home Services
Program Manager
Adult Day, Senior In-Home Services, National Family Caregiver Support:
Cyndee Simpson-Sugar
Program Manager
Division of Senior and Disabilities Services
PO Box 110680,
Juneau, Alaska 99811-0680
Phone: (907) 465-4798
Fax: (907) 465-1170
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