Enroll in PEAK 2.0

Please use the form below to enroll in PEAK 2.0.

Note: Fields marked with * are required.

If you are unable to find your home name below please contact the K-State Center on Aging at 785-532-2776 or ksucoa@gmail.com.

Home/Facility: *

Address Line 1: *

Address Line 2:

City: *

State: *

Zip/Postal Code: *

Administrator Name: *

Administrator Email: *

Administrator Phone: *

PEAK Contact Name: *

PEAK Contact Email: *

PEAK Contact Phone: *