Mennonite Memorial Home Apply

A separate application for residency is required for each person expecting to enter Mennonite Memorial Home. Acceptance of applicants does not depend upon race, religion or national origin. MMH is a smoke-free environment. People who smoke may not reside at Mennonite Memorial Home.

This application is an initial step only and serves to place an applicant's name on our waiting list. More information will be requested at the time of admission.

A non-refundable application fee of $50 is required and should follow this application.

Please send check to:
Mennonite Memorial Home
Attention: Admissions
410 W. Elm Street
Bluffton, Ohio 45817

Please answer all questions.

Applicant's Information

Mr.

Mrs.

Miss

Name*

Present Address

Street*

City*

State*

Zip*

Telephone*

Email Address*

username@domain.com

Name of
Living Spouse

Date of Birth*

First Contact Person
Name*
Relationship*
Telephone*
Street*
City*
State*
Zip*
Second Contact Person
Name*
Telephone*

Are you willing to abide by the Home's smoke-free policy?

Yes

Expected time of entry:

soon (active list)

indefinite* (inactive list)

Mennonite Memorial Home should communicate with:

applicant

contact person

I am interested in:

Cottage

Assisted Care

Dogwood Hall

Nursing Care:
	Regular Floor	Special Unit

Unknown at this time

* Please note that persons answering "indefinite" will be informed of an opening only after the Home has been told that entry is requested soon.

* required fields