Skip to content
Facebook
Twitter
LinkedIn
Instagram
CAREGIVER LOGIN
Search for:
Who We Are
Services
Mission Statement
AFCNS Difference
Team
CARF International
Careers
How We Help
Who Qualifies
Family Member Solutions
Financial Solutions
How to Become a Client
Apply for Services
Caregivers
What is a Caregiver
Respite Care
Financial Solutions
How to Become a Caregiver
Apply to be a Caregiver
Caregiver Training
and Log
Caregiver Grievance/Incident Form
Caregiver Connections: Shared Resources
Professionals
How AFCNS Can Help
Apply for Services
Book a Presentation
Did You Know
FAQ
Director’s Corner
Community Involvement
Useful Contacts
REQUEST INFORMATION
First
Last
Email
Phone
Zip
How Did You Hear About Us?
Social Media
Google Ad
Newspaper
Referral/Word of Mouth
Other
APPLY FOR SERVICES
Applicant Information
Name
(Required)
First
Last
Date of Birth
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone Number
(Required)
Email Address
Enrolled in MassHealth?
(Required)
Yes
No
Unsure
Need assistance with any of the following? You may select more than one.
(Required)
Select All
Bathing
Dressing
Toileting
Mobility
Being Fed
Currently lives with a Caregiver?
(Required)
Yes
No
If you are completing this form for someone else, please complete the following:
Your Name
First
Last
Your Phone Number
Your Email Address
Your Relationship to the Applicant:
Next Steps
Who should be contacted to arrange an intake appointment?
(Required)
First
Last
Phone
(Required)
How did you hear about us?
(Required)
Referral/Word of Mouth
Social Media
Google Ad
Newspaper Ad
Other
Phone
This field is for validation purposes and should be left unchanged.
APPLY TO BE A CAREGIVER
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Note: You must reside in Massachusetts.
Phone Number
(Required)
Email Address
Do you have a spare bedroom?
Yes
No
Briefly explain your caregiving experience:
(Required)
How did you hear about us?
(Required)
Referral/Word of Mouth
Social Media
Google Ad
Newspaper Ad
Other
Caregiver Training Login
Please enter your password: