Admissions Forms

You can download an application from the following list. It can be printed, filled out, and mailed to: Department of Health & Social Services - Division of Alaska Pioneer Homes
PO Box 110690
Juneau, AK 99811-0690

• Alaska Pioneer Homes Application 2011
• Application Instructions 2011
• Alaska Veteran and Pioneer Home-Veteran's Addendum
• Admissions & Discharge Information Booklet
• History and Physical Form
• Certificate of Need Form
• MOST (Medical Orders for Scope of Treatment) form

Click here for information regarding the Payment Assistance Program

Also available online are the Alaska Pioneer Home System Statutes and Regulations.

For more information contact:

Dave Cote, Director
Division of Alaska Pioneer Homes
Central Office, P.O. Box 110690
Juneau, AK 99811-0690
Phone: (907) 465-5737
Fax: (907) 465-4108