Meals on Wheels Client Application

Please enter a valid phone number.

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

Please enter a valid phone number.

Call ApplicantCall Contact

Please enter a valid phone number.

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. Those under 60 may utilize the program but would be required to pay $9.00 per meal.*

IndependentMinimum AssistanceModerate AssistanceMaximum Assistance

$31,650 or less$31,652 to $52,700$52,701 to $77,700$77,701 or more

$36,200 or less$36,201 to $60,250$60,251 to $88,800$88,801 or more

$40,700 or less$40,701 to $67,800$67,801 to $99,900$99,901 or more

$45,200 or less$45,201 to $75,350$75,351 to $110,950$110,951 or more

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