I Need Help - Online Referral Form

If you or someone you know would be interested in receiving a free call from SWIRCA about options for in-home services or learn more about community resources, please click the button below to complete the online referral form. Or if you prefer to download, print and complete the printed version, that option is also available below.

Online Referral Form

Printed Referral Form


Please mail your printed form to:
SWIRCA & More
16 W. Virginia Street
Evansville, IN 47710
Attn: Aging and Disability Resource Center

Download and Print Form Here


An Options Counselor will follow up with you to find out more about you and provide you with individualized options.