Pre-Admission Checklist

Here is a checklist for pre-admission

Application:

Completed Actors Fund Home Application
Eligibility Information - proof of profession in the Entertainment Industry (resume, union, pensions, playbills, articles, union earnings printout)
Copy of Advance Directives
- Living Will
- Health Care Proxy
- Power of Attorney
- Guardianship papers
Copy of Birth Certificate OR valid US Passport
Verification of any name change (copy of court order)
Copy of Medicaid documentation if applicable
Copy of Social Security Card (front and back)
Verification of Social Security monthly amount (award letter OR direct deposit on bank statement)
Copy of Medicare Card (front and back)
Copy of All Insurance Cards (front and back)
Copy of Medical/Prescription Insurance Cards (front and back)

Copy of current Financial Statements (all pages of all accounts: checking, investments, savings, Retirement, etc.)
Copy of most recent Tax Return
Copy of Pension check stub showing deduction and net amount
Copy of Life Insurance policy
Copy of ANY documentation on Long Term Care Insurance policy

5 years of Bank Statements and other accounts (all pages)
5 years of Tax Returns
Copy of Social Security Award Letter and/or Pension check stub
Proof of Marital Status: Marriage Certificate, Divorce Papers or Death Certificate
Outstanding debt owed such as credit card, mortgage, loans, IRS, etc.
Proof of residency for the past 5 years: Rent Receipt, Apartment Lease or Deed
Deed to house and/or transfer deed if land or house was transferred
Closing statement for any land or real estate sold within the past 5 years
Copy of Pre-Paid Funeral Arrangements/ deed to cemetery plot