• National Aging Program Information Systems Registration Form

    Food Distribution Program - NAPIS - APD 0001 (02/2019)

  • 721 SE 3rd, Suite D
    Pendleton, OR 97801
    541-276-1926 | 800-752-1139

     

    Serving Gilliam, Hood River, Morrow, Sherman, Umatilla, Wasco, and Wheeler counties

  • All fields marked with an asterisk (*) are required.

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  • Welcome! We’re glad you’re here. Would you help us by telling us a bit about you? Services are funded in part by the Older Americans Act, a federal program since 1965. Annually we report demographics of participants. All information is confidential - we do not report personal information - only age, gender, race, zip code, poverty, etc.

  •  Section I – Tell us about you
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  •  Section 2 - In case of an emergency - please contact (Optional information)
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  •   Section 3 - Nutritional data (Please check all that apply)
  •  Section 4 - Activities of daily living* and instrumental activities of daily living
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