• Meals on Wheels Collin County - Application/Referral Form

  • Notice: We are unable to provide vegetarian-only meals or accommodate special diets. Please see our meal calendar on our website under 'Resources' for an idea of the meals served.

    IMPORTANT: Please complete a separate application for each individual applying. If multiple people are applying, each person must submit their own application

    To see what is on the menu, follow this link Here

  • Eligibility Check

  • Date of Birth*
     - -

  • Client Information

  • Date filling out application*
     - -
  • Were you a previous client for MOWCC?*
  • Format: (000) 000-0000.
  • Gender*
  • Client Race/Ethnicity*
  • Do you require a translator?*
  • Marital Status*
  • Veteran Status*

  • Health/Mobility Information

  • Do you live alone?*
  • Are you receiving other food assistance services?*
  • Do you use a mobility aide?
  • Please select applicable health conditions:*

  • Referral Submitter Information

  • Format: (000) 000-0000.
  • Are you also the emergency contact?
  • Is the client aware of referral?

  • Emergency Contact Information

    Please provide emergency contact information
  • Format: (000) 000-0000.
  • Should be Empty: