Moving In
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Application for Admission

Notice: Michigan Masonic Home and Jack F. Sanders Health Care Center rates effective April 1, 2007 and subject to change with 30 days notice. Masonic Village Estates rates effective April 1, 2007 and subject to change with 60 days notice.



Demographic Information


Full Name: 
Nickname:
Date of Birth: 
SSN: 
Current Address: 
E-Mail Address:   
Are you a current Michigan Resident?
Since When?
Are you a U.S. citizen?
City / Country of Birth: 
Ethnicity: ( Check Below )Marital Status: ( Check Below )



Wedding Anniversary:
Spouse's Name:
Are you a veteran of the U.S. Armed Services?
Service Branch:
Dates of Service:
Do you currently receive Veteran's Benefits?
Veteran's Number:
Father's Name:
Mother's Name:
Primary Occupation Prior to Retirement

Move-In Assistance

Let us help make your transition as easy as possible! Our Environmental Services Department is here to assist you on move in day, to provide carts and staff to help in the actual moving of items from vehicle to your new room. Our Maintenance Department staff will assist with programming the television, answering machine, and hanging wall decorations.