Form Center

If "Save Progress" feature doesn't save your progress, please clear your browser cache.
By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Bright Light Program Application

  1. Aurora Senior Services Logo
  2. Person Submitting Information

  3. Nominee

  4. Is the nominee 18 years or older?*
  5. If under 18 years old, please provide parent/guardian contact information.

  6. Leave This Blank:

  7. This field is not part of the form submission.