NIGHT OWL SUPPORT SYSTEMS, LLC | P.O. BOX 259293 | MADISON, WI 53725 | TOLL FREE: 877-559-1642 | FAX: 608-960-4003 608-960-4001

North Carolina Pilot Program

Having trouble completing the Program Form online?

Download File

Fax completed form to: 608-960-4003

  • Want to upload an already filled out form?
  • NOSS Supports Checklist

  • Case Manager

  • Primary Contact

  • Equipment available to guests

  • -Panel (Always in use)
  • -Smoke Detector (Always in use)
  • -Personal Pagers – (necklace, watchband and/or mounted bathroom pager), Flood Sensor (in bathroom) (Always in use)
  • -Thermostat Sensor (Always in use)
  • -Exterior Door Sensors
  • -Window Sensors
  • -Cabinet Sensor
  • -Refrigerator Sensor
  • -Freezer Sensor
  • -Bed Sensor (sends an alert if someone has been out of bed for a predetermined amount of time)
  • -Motion Sensors
  • **Please note this form is for the Remote Pilot Home ONLY. If you will be utilizing NOSS services in your home, please fill out the NOSS Referral Form**