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SHIIP--SMP Volunteer Counseling Supplies Order Form

Counseling Tools - for Counselor use only.  One copy per Counselor please.  Images provided for resources may not represent the most recent version.

Counseling Tools and Supplies

Red SMP Card Front
Red SMP Card Back
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Factsheets and Forms

Medicare Prescription Drug Coverage
Section 3 of 9 in this document

Folders

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Displays and Event Materials

These may be borrowed from the State Office, but must be returned after your event is over.

Displays - Check all that you want to order

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Guides

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Promotional Materials

Section 7 of 9 in this document

Volunteer Recruitment Materials

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Supply Distribution Information

Full Name

Delivery Method

Mailing Address

Date Needed By. Reminder, it may take up to two weeks to process your order, unless you are ordering for a Welcome to Medicare Seminar in which case your order will be processed the day it is received.

Date Picker

Supplies will be used for: