MDA email — Community Elder Care Programme
Email Templates / MDA Emails
Community Elder Care Programme — MDA Submission Email
Sent to the National Assistance Board when an applicant submits the Community Elder Care Programme application form.
Preview:
New Community Elder Care application received
Service
Community Elder Care Programme
Reference number
CEC-XXXXXX
Submission date
[DD/MM/YYYY]
Submission time
[HH:MM]
Applicant contact
[applicant@email.com]
Here is the data submitted with this application:
Recipient details
First name
[First name]
Middle initial
[Initial]
Last name
[Last name]
Date of birth
[DD/MM/YYYY]
Sex
[Male / Female]
National Registration No.
[YYMMDD-XXXX]
Street address
[Address]
Parish
[Parish]
Home phone
[Phone number]
Cell phone
[Phone number]
Marital status
[Status]
Contact person
Full name
[Name]
Title / role
[Title]
Ministry / agency
[Ministry or agency]
Email
[email@example.com]
Phone
[Phone number]
Income and background
Monthly income (BDS$)
[Amount]
Income source
[Source]
Other income sources
[Sources and amounts]
Monthly medical expenses (BDS$)
[Amount]
Monthly rent / utilities (BDS$)
[Amount]
Household members
Household members
[Names of household members, or "Lives alone"]
Physical condition — sight and hearing
Vision
[Normal / Impaired / Blind]
Hearing
[Normal / Impaired / Deaf]
Physical condition — build and mobility
Height
[Height]
Size / build
[Small / Medium / Large / Obese]
Mobility
[Ambulant / Uses walking aid / Wheelchair / Bedridden]
Illnesses / disabilities
[Description or "None reported"]
Mental status
Memory / orientation
[Good / Fair / Poor / Other]
Memory / orientation detail
[Details if "Other" selected]
Behaviour / mood
[Cooperative / Depressed / Aggressive / Other]
Behaviour / mood detail
[Details if "Other" selected]
Communication
[Verbal / Non-verbal / Other]
Communication detail
[Details if "Other" selected]
Assistance required
Services requested
[List of selected services]
Special notes
[Notes or "None"]
Declaration
Applicant's name
[Full name]
Date signed
[DD/MM/YYYY]
Email address
[email@example.com]
Declaration accepted
Yes
Due date: [To be filled by officer]
Social worker assigned: [To be filled by officer]
Notes: [To be filled by officer]
New Community Elder Care application received
Service
Community Elder Care Programme
Reference number
CEC-XXXXXX
Submission date
[DD/MM/YYYY]
Submission time
[HH:MM]
Applicant contact
[applicant@email.com]
Here is the data submitted with this application:
Recipient details
First name
[First name]
Middle initial
[Initial]
Last name
[Last name]
Date of birth
[DD/MM/YYYY]
Sex
[Male / Female]
National Registration No.
[YYMMDD-XXXX]
Street address
[Address]
Parish
[Parish]
Home phone
[Phone number]
Cell phone
[Phone number]
Marital status
[Status]
Contact person
Full name
[Name]
Title / role
[Title]
Ministry / agency
[Ministry or agency]
Email
[email@example.com]
Phone
[Phone number]
Income and background
Monthly income (BDS$)
[Amount]
Income source
[Source]
Other income sources
[Sources and amounts]
Monthly medical expenses (BDS$)
[Amount]
Monthly rent / utilities (BDS$)
[Amount]
Household members
Household members
[Names or "Lives alone"]
Physical condition — sight and hearing
Vision
[Normal / Impaired / Blind]
Hearing
[Normal / Impaired / Deaf]
Physical condition — build and mobility
Height
[Height]
Size / build
[Small / Medium / Large / Obese]
Mobility
[Ambulant / Uses walking aid / Wheelchair / Bedridden]
Illnesses / disabilities
[Description or "None reported"]
Mental status
Memory / orientation
[Good / Fair / Poor / Other]
Memory detail
[Details if "Other"]
Behaviour / mood
[Cooperative / Depressed / Aggressive / Other]
Behaviour detail
[Details if "Other"]
Communication
[Verbal / Non-verbal / Other]
Communication detail
[Details if "Other"]
Assistance required
Services requested
[List of selected services]
Special notes
[Notes or "None"]
Declaration
Applicant's name
[Full name]
Date signed
[DD/MM/YYYY]
Email address
[email@example.com]
Declaration accepted
Yes
Due date: [To be filled by officer]
Social worker assigned: [To be filled by officer]
Notes: [To be filled by officer]