• Application/Referral Form for Meals on Wheels Denton County

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    Notice: Meals on Wheels of Denton County operates on a fixed menu and is unable to accommodate special diets, including but not limited to vegetarian, gluten-free and allergy-related individual requests. All meals are overseen by a registered dietician to ensure that each meal is nutritionally balanced; please see the meal calendar on our website under "Resources" or click here for more information on what is typically provided. 

    Important: Meals on Wheels of Denton County currently has an extensive waitlist for new clients, as there is a high demand for services at this time. Filling out an application will add you that wait list in the order in which it was received by the organization. We are unable to provide an exact timeline for when new clients will be added to the program, but are happy to receive new applications and will contact you as soon as possible! 

    Please complete a separate application for each individual applying to the Meals on Wheels program. In the event of multiple applicants, even if they are in the same household, an application must be submitted for each person requesting services.

     

     

  • Meals on Wheels Denton County

    Client Application/Referral Form

  • Applicatants MUST be 60 years of age or older to qualify.

  • Date of Birth:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Personal Information

  • Application Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you a New or Returning Client of MOW of Denton County?*
  • Format: (000) 000-0000.
  • Client Sex:*
  • Client Race/Ethnicity*
  • Do you require a translator?*
  • Marital Status*
  • Veteran Status*

  • Health and Mobility Information

    To be filled out by the client or on behalf of the client.
  • Do you live alone?*
  • Are you receiving other food assistance services?*
  • Do you use a mobility aide?*
  • Please select applicable health conditions:*

  • Referral Information

    If you are referring someone else for MOW Denton County, please provide YOUR information here.
  • Format: (000) 000-0000.
  • Are you also the emergency contact?
  • Is the client aware of the referral?

  • Emergency Contact Information

    Please provide emergency contact information. At least one emergency contact is required.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Should be Empty: