Dinwiddie CCHASM Thanksgiving Registration 2025 through CCHASM

Dinwiddie Residents only form M.A. Weeks Thanksgiving Program Friday November 21, 2025 Eastside Enhancement Center 7301 Boydton Plank Rd., Dinwiddie, VA 23803

**SUBJECT TO AVAILABILITY**
This form is only for Dinwiddie residents. If you do not live in Dinwiddie County, please stop and fill out the other form on our website.

We also this year have a limited delivery option. Please read carefully.

One Meal Bag per Mailing Address/Household (Duplicates will be removed)

1. A valid picture identification (ID) is required. Example: Driver's license, photo identification, passport, etc. ONE MEAL PER HOUSEHOLD/STREET ADDRESS

AND

2. A CCHASM Thanksgiving Meal Package Confirmation Email (printed or displayed on an electronic device such as a smartphone, tablet, computer, etc.).
1. LAST NAME ........................................................FIRST NAME *

LAST NAME EX: SmithFIRST NAME EX: Bob
2. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. I certify that I am a Dinwiddie resident.*
4. Children in your household under 18*
Enter number of children, if none enter "0"
5. Adults in your household (including yourself)*
Enter total number
6. Email Address (if no email, then leave blank)
example@example.com
7. Telephone Number*
Please enter a valid phone number.
There is a limited Meal Delivery Option: Only if:

1. over 65+ or

2. Disabled or

3. No transportation and no one to come and pick up bag for you

Check your address from the following list below using Google Maps to one of these addresses.

Meal Delivery Option. Home-delivered Thanksgiving Meal Package (ONE MEAL BAG PER HOUSEHOLD/STREET ADDRESS) is available (limited availability) for those who reside within a 15-mile radius of either of these locations:

VCRC ( Virginia Community Resource Center)22 West Washington Street, Petersburg VA 23803 Thursday November 20.

City Point Restoration Church, 2300 Bluefield St, Hopewell, VA 23860, Thursday November 20.

If you believe you meet at least one (1) of the qualifications (i.e., over age 65 years old, a person with disabilities, lack transportation), choose the delivery option and we will be in touch with you regarding this request.

It is not guaranteed that you will be able to receive delivery, we will reach out and contact you if you qualify.
8. We have the following in Dinwiddie, we have the following pick up options: *
Check above if you live within the 15 mile radius of a delivery hub.
9. If you are requesting delivery, choose all that apply.
10. Appointment time: Friday November 21, 2025: Dinwiddie Distribution Site: Eastside Enhancement Center, Dinwiddie VA. Choose your time you will pick up your food bag and grocery gift card. *
Please select when you are able to come and pick up your bag and gift card.
11. In my household, there is an individual over 65 years of age.*

YesNo
12. In my household, there is a veteran.*

YesNo
13. I found this program through_______ (select up to 3)?*

FamilyFriend(s)ChurchCommunityTV/RadioSocial media (Facebook + Instagram @CCHASM_VA, Twitter @CCHASM)
14. My primary language is*

EnglishSpanishOther
15. My annual household income range is*

Less than $25,000$25,000 - $49,000$50,000 - $75,000Over $75,000None
16. Race/Ethnic Background*

Native American/American Indian/IndigenousAsian American/Asian Pacific Islander/HawaiianHispanic/Latino/LatinaBlack/African American/AfricanWhite/Caucasian/European Multi-RacialMulti-ethnic (2 or more races or ethnicities)
17. Check this box (Required)*

I certify that I live within the designated area and meet the income requirements to qualify for this program. I certify that I have submitted a request for one meal bag per household/street address. If I have registered more than one meal bag per household/street address, I understand that I will be provided one meal bag.
18. Check this box (Required)*

I MUST bring a valid picture ID that shows my current address. If my address has changed, I MUST bring BOTH my valid picture ID and a current utility bill with my address.
19. Check this box (Required)*

I realize that if I selected a DELIVERY option, this is not complete until I hear from an associate at CCHASM through email or phone. We will make every effort to contact you.
Should be Empty:

Dinwiddie Residents only form M.A. Weeks Thanksgiving Program Friday November 21, 2025 Eastside Enhancement Center 7301 Boydton Plank Rd., Dinwiddie, VA 23803