Enrollment Submission Form If you have an interest in the PACE program and wish to be considered for enrollment, please submit the following. Name*Phone*Birth Date*Address including Zip Code*How did you hear about PACE Greater New Orleans?*With whom does the PACE applicant live?*Required assistance with such things as cooking, bathing, dressing, mobility or shopping.*Is the applicant currently enrolled in Medicare?*Is the applicant currently enrolled in Medicaid?*Is the applicants monthly income less than $2,022 if single?*Is the applicant's monthly income less than $4,044 if married?*Is the applicant's savings less than $2,000 if single?*Does the applicant have any life insurance policies?*Are you more interrested in the Westbank or Eastbank PACE facility?