Métis Elders and Seniors Assistance Program Application

Review the Métis Elders and Seniors Assistance Program page for eligibility, availability, required information, and contact details before completing this form.

Métis Elders and Seniors Assistance Program (MESAP)

Name(Required)

First Name Last Name

Address(Required)

Street Address Address Line 2 City Province Postal Code

Date of Birth(Required)

Citizenship Number(Required)

Applying as(Required)

Applying as a Single Applicant $3,000

Applying as a Couple Applicant $4,500

Please describe what health-related equipment or services you are applying for(Required)

Annual Household Income

Annual Household Income(Required)

(If applying as a couple, please upload the first Notice of Assessment here; the second one can be submitted through the next statement – applications will not be complete without Notice of Assessments.)

Accepted file types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip, Max. file size: 10 MB.

If applying as a couple, please upload a copy of your second notice of assessment(Required)

(If applying as a couple, please upload your partner’s Notice of Assessment here.)