Meals on Wheels Client Application

(in King County, WA)

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(A separate application is required for each person applying for the program)0/255

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Call ApplicantCall Contact

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Temporarily homebound (convalescing)Homebound some days, not othersLong term homebound

*To be eligible for services, an individual needs to meet the following criteria: Age 60 or older, homebound, unable to prepare meals, difficulty performing activities like bathing, dressing or shopping, and does not have an informal support system.*

IndependentMinimum AssistanceModerate AssistanceMaximum Assistance

$33,050 or less$33,051 to $55,000$55,001 to $84,850$84,851 or more

$37,750 or less$37,751 to $62,850$62,851 to $96,950$96,951 or more

$42,450 or less$42,451 to $70,700$70,701 to $109,050$109,951 or more

$47,150 or less$47,151 to $78,550$78,551 to $121,150$121,151 or more

ApplicantOther - provide name and relationship

Meals on Wheels Application

Applicant Information

Emergency Contact

Contact Instructions

Reason for needing Meals on Wheels

Health Information

Disabilities

Nutrition Information

Activities of Daily Living

What level of assistance do you need with the following?

Applicant Demographic Information